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A TREATISE 



GENERAL PATHOLOGY, 



AND ITS RELATION TO 



^tactical Ipedicme. 




CHARLES L. CARTER, M. ])., 

HONORARY MEMBER OF THE ST. LOUIS MEDICAL SOCIETY; LATELY SURGEON 
IN THE UNITED STATES ARMY. 



SECOND EDITION REVISED. 



2-Ho-)H^t 



ST. LOUIS: 

Woodward & Tiernan Printing Co., 309-319 North Third Street. 

1891. 



*\ 



\f\\ 



Entered according to Act of Congress, in the year 1891, by 

CHARLES L. CARTER, M. D., 
In the office of the Librarian of Congress, at Washington. 






£ 



FACULTY AND ALUMNI OF HIS ALMA MATER, 



THE ST. LOUIS MEDICAL COLLEGE, 



AS A TRIBUTE OF LASTING RESPECT AND FRATERNAL REGARD, 



THIS BOOK IS DEDICATED BY 



% gu%r 



INDEX. 



ADDRESS. 

THE PERSISTENCE OF ERROR 11 

CHAPTER I. 

RELATIVE VIEW OF ORGANIC AND INORGANIC MATTER 17 

CHAPTER II. 

CONDITIONS OF FORM AND ACTIVITY OF MATTER 24 

CHAPTER III. 

COMPARATIVE VIEW OF PHYSIOLOGY AND PATHOLOGY 34 

CHAPTER IV. 

ETIOLOGY— THE CAUSES OF DISEASE 44 

CHAPTER V. 

ELEMENTS OF DISEASE 58 

CHAPTER VI. 

QUANTITATIVE CHANGES OF THE BLOOD AND THEIR RESULTS 67 

CHAPTER VII. 

ACTIVE CONGESTION— RESULTS — REMEDIES 83 

CHAPTER VIII. 

PATHOLOGICAL CHANGES IN THE PROXIMATE PRINCIPLES OF THE BLOOD 96 

CHAPTER IX. 

THE IDIOPATHIC, OR ESSENTIAL FEVERS Ill 

CHAPTER X. 

TETANUS, GANGRENE, AND SYPHILIS 134 

CHAPTER XL 

SEMEIOLOGY AND DIAGNOSIS— PROGNOSIS 141 

CHAPTER XII. 

GENERAL THERAPEUTICS 150 



PREFACE TO FIRST EDITION. 



The science of Pathology, by the combined effort and 
continued research of its votaries, has emerged from the 
clouds of Hypothesis which enveloped it in embryo ; but 
this advancement has not produced a corresponding refor- 
mation in the Practice of Medicine. Why is this ? Pathol- 
ogy has been cultivated by comparatively few in the Pro- 
fession. Too many plod their way in unwarrantable routine, 
or in the sin of Empiricism. By such, the development, 
changes, and career of the human organism, if at all 
observed, are viewed as the vagaries of Hypothesis, or 
referred to the absurd agency of Chance. 

The design of this work is to present the outlines of 
General Pathology in its present advanced position as a 
Science, and its instructive bearing upon Practical Medicine. 

I have designed brevity and perspicuity of language in 
the work, which is written currente calamo, expressing my 
own views in my own manner ; though, on some points of 
the subjects embraced, I have been materially aided by 
recent and eminent authorities. I have written almost the 
entire work in the present year, during the intervals of 
leisure afforded by an extensive practice. This may suffice 



Vlll PREFACE. 

if an apology for the style of the work be deemed necessary ; 
but for the principles advocated, no apology is offered nor 
indulgence asked. 

I shall be the recipient of the most desired remuneration, 
and shall have attained my highest aim, if this Volume 
contribute, in any degree, to the amelioration of human 
suffering, and the promotion of the Profession to which I 
am ardently devoted. C. L. C. 

December, 1866. 



PREFACE. 



SECOND EDITION, REVISED. 



Pathology is to many physicians obscure ; to me interest- 
ing ; to our profession important ; to our race beneficent. 

After years of ardent study, careful investigation and 
active practice, I present this treatise to the profession as a 
venture, as it is written from a standpoint totally independ- 
ent of the censorship of creeds, schools and traditions. It 
is a source of gratification that this humble essay has been 
approved by many profound thinkers and some leading 
schools. 

The first edition, 2,500 volumes, having been exhausted, 
the demand for the book calls for a second edition. 

The work has been carefully revised, new matter added, 
and is again offered to the profession as a concise treatise on 
general Pathology. 

El Dorado Springs, Mo., June, 1891. 



(ix) 



THE PERSISTENCE OF ERROR. 



Mr. President and Doctors: — I am not here to disparage you 
with unfriendly criticism nor to regale you with flattering 
unction. We are all here to work by the rule of addition — 
to cast together all we think we know, then eliminate all 
we do not know — what remains is the known quantity. 
Should this appear infinitesimal, it may be augmented and 
potentialized by this coming together. 

Our profession demands the aid of the iconoclast. Into 
every field of thought error obtrudes with alluring blandish- 
ments. In the religious, error most abounds, and longest 
persists. The reason of this is obvious ; theology rests upon 
the fiat of deduction, rather than the scrutiny of induction. 
The religions are not beautiful systems of morals, veiled in 
allegory and illustrated by symbols, but antiquated tra- 
ditions, founded on superstitions and enforced by dogmas ; 
their creeds claim for their codes divine sanction, and sub- 
missive faith without investigative reason marks the highest 
attainment of their votaries. No wonder, then, that in these, 
error does much abound. 

With these prelusory remarks, let us now consider the 
profession of medicine in which I am sure we are all pro- 
foundly interested. In this we deal mainly with inductive 
reason, and in this, great minds have labored, great advances 
have been made, and great blessings have come to mankind. 
Our triumphs are too glorious for oblivion and too numerous 
to mention now. But this is our bright side. 

* An address delivered before the Tri- county Medical Association, at Butler, 
Mo. , by the Author. 

(ii) 



12 GENERAL PATHOLOGY. 

We must confess some errors, and these we may profitably 
discuss here and now. We are not to consider the long list of 
absurd superstitions, never sanctioned by the profession, but 
believed by some people ; as carrying a potato in the pocket 
for rheumatism — or buckeye for piles, a comb in the bosom 
for mammary abscess, and so on almost ad infinitum. But 
I wish to notice some of the errors which the profession has 
indorsed, and even now practice. It is not wonderful that 
the profession has at times gone dashingly into error, for 
that is human ; but the strange thing is that wrong princi- 
ples and practice on some things have so long persisted. 
Hippocrates taught that amputation could only be safely 
performed through dead tissues, and that notion prevailed 
and governed the practice of surgery for two thousand years, 
till the time of Pare. Insane and epileptic people were as 
long believed to be possessed of a devil till the time of Pinel. 
Doctors persistently believed that the arteries contained air 
for more than fifteen hundred years. Th e lamented Servetus, 
who was burned at Geneva as a heretic in 1553, was the first 
to trace the circulation of the blood from the heart to the 
lungs and back to the heart. To suppress science, Dr. 
Michael Servetus was burned, and all of his writings except 
two volumes. 

Down to a time within the memory of some of you, and 
when I began the practice of medicine, thirty-three years ago, 
mercurial salivation and heroic blood-letting were endorsed 
as orthodox treatment in most forms of disease — then it was 
as usual for a doctor to carry a lance as it is now to carry a 
thermometer ; the former has long been laid aside, and the 
latter must be relegated to the hand of the quack ! Then 
fever patients were not permitted to taste cold water, the 
prescribed drink was tepid water, in which was the ubiqui- 
tous burnt crust — then ptyalism played havoc with multiplied 
thousands of confiding patients, especially in syphilis, and 
the ravages of mercury were thought to be the ravages of 
syphilis — and were worse. 



THE PERSISTENCE OF ERROR. 13 

The long use of the stethoscope is another example of the 
persistence of error. For forty years the medical profession, 
from the learned professor to the mere tyro and the cheeky 
charlatan, deftly plied that instrument and looked pro- 
foundly wise. Even as late as two years ago I saw the late 
Dr. Flint go through the delusive farce of using the stetho- 
scope, pleximeter and mallet, in the presence of 500 doctors 
and medical students in Belle vue. Perhaps dotage and 
puerile love of show form his best apology, but I was 
impressed with the fact that the Flint practice, like the flint 
lock, has had its day, for the profession has finally stamped 
out, lived down and risen above these imposing delusions. 

Old Sam. Thompson said, "Heat is life, and cold is death." 
In this the venerable steam doctor was about right. More 
recently, but with less genius, many doctors, especially 
juveniles in practice and drones in pathology, have become 
morbidly afraid their patients will get too warm. This heat 
craze has impregnated clinical medicine with bastard twins 
— the clinical thermometer and cold baths in typhoid fever. 
Tepid baths impregnated with salt and soap are indispen- 
sable in the treatment of the low grades of fever, but the 
immersion of such patients in cold water too often proved 
fatal, consequently one of the twins died, but the other is 
still dragging out an unprofitable existence, and is the 
vade mecum of various grades of doctors, including professors, 
novices and mountebanks. In their hands that little guess- 
ing tube is as the cane in the hand of the dude, the divining 
rod in the hand of the water-witch, or the wand in the hand 
of the magician. They insert the little tube into the mouth 
or axilla of their patient (of a horse would do as well), let it 
remain awhile; ad interim, they assume an air of deep 
solemnity and amazing profundhy. Then they take it out, 
examine it carefully, and guess how their patient is getting 
along. Wonder how long this delusion will persist ! Not 
always, nor long, for the people will soon come to look upon 
the tube as an emblem of weakness. Besides, I have great 



14 GENERAL PATHOLOGY. 

confidence in the conscientiousness, the learning and the 
honor of the better class of the profession. 

A real doctor should be void of shams ; should be able to 
apply ripe culture and clinical experience to determine the 
conditions and indications presented . by the tongue, pulse, 
skin and many other such reliable avenues to verity and 
success. 

Typhoid is a continued fever depending upon essential 
morbid elements in the blood, and is of low but varying 
grades. Do not err by calling each grade a kind. In the 
old or long settled portions of this country, fever is generally 
of a low grade, or typhoid type. Our old-fashioned bilious 
fever is passing — indeed, has passed — into typhoid. I have 
seen individual cases do this, but the general and gradual 
transition has kept pace with the plow until now typhoid is 
the prevailing type of fever. The disease is congestive, the 
temperature variable, warmth and coolness local and alter- 
nating, hence, thermal test impossible and absurd. The 
patient is better warm than cold. 

The schools evidently err in plunging patients affected 
with sun-stroke or heat-stroke into cold baths or ice boxes. 
They would do better to immerse the body in tepid water, 
and apply ice to the head. 

Another error is the prescribing of cod liver oil in phthisis. 
It is worse than worthless ; it would blunt the appetite and 
derange the stomach of a buzzard, and has hurried many 
patients to the grave. The new and novel, yea, ludicrous 
and futile mode of treating phthisis by inflating the bowels 
with sulphuretted hydrogen and carbonic acid gasses, is 
offensively absurd. If the first mentioned gas were curative, 
the flatus of that gas which is generated in the bowels and is 
very abundant in consumptives would work a natural cure. 
Humanity demands that doctors intent on display should 
be merciful and not stink their patients to death. Observa- 
tion and experiments are the progenitors and promoters of 
science, but the essential element is truth, or verification. 



THE PERSISTENCE OF ERROR. 15 

M. Pasteur's inoculations for the prevention and cures of 
hydrophobia unfortunately failed to develop a fact or 
elucidate a truth ; the practice is now known to rest upon an 
error, and the Austrian hospital directors, after numerous 
experiments at Vienna, have suppressed such inoculations. 

These are not all, but why do such errors persist from day 
to day, from year to year, and from generation to generation ? 
Too many are graduated into the profession without the 
requisite literary qualifications and peculiar intellectual 
endowments necessary to make doctors ; too many medical 
schools are in operation ; too many men are filling professors' 
chairs and conducting clinics, who are too illiterate and 
uncultured in general science to grapple with abstruse 
problems, differentiate clearly, or reason profoundly ; too 
many in such positions, especially in New York, are too 
young and inexperienced for teachers. I saw a professor in 
one of the New York clinics examine a child six weeks old 
and pronounced the disease incurable paralysis, caused by 
pressure of the brain during parturition. I privately sug- 
gested to the professor that the child's arm was luxated at 
the shoulder, and that proved to be all that was the matter. 
That professor is a specialist "good on the brain," in New 
York, too, the assumed Bag-Dad of medical learning ; hence, 
doctors are not to be weighed according to the size of the 
town in which they reside, nor even by their position; 
neither should verbose pomposity nor its equivalent dullness 
be taken for dignity nor wisdom. Unwarrantable assump- 
tion, incapacity to investigate, a desire to ape others, or 
greed of gain, too often mar our profession. We want more 
men in medicine, in religion and in politics, who have the 
brains to think and the bravery to tell the truth, whether it 
makes them heretics or heroes, martyrs or monarchs. 



A TREATISE ON 

GENERAL PATHOLOGY. 



CHAPTER I. 

RELATIVE VIEW OF ORGANIC AND INORGANIC MATTER. 

The primitive and ultimate state of all matter is inorganic. 
Hence, the earth is the prolific mother of the countless 
myriads of living organisms that dot her broad periphery. 
Millions of human beings bask in her genial climes, and 
luxuriate in the variety and abundance of her productions — 
countless tribes of animals subsist upon her bounties, and 
traverse her ample domain — numerous nations of plants rise 
from her bosom, extend their stately boughs, and unfurl 
their tender leaflets to the gentle zephyrs, to furnish oxygen 
and food for their superiors in organization. Yet, each of 
these living organisms is composed of the material that con- 
stitutes the rivers and mountains. Each one is formed a 
model of its kind ; endowed with properties of matter and 
conditions of activity, and regulated by laws instituted by 
the Creator of the Universe. Each is as a parasite receiving 
directly or indirectly from the earth the supplies necessary 
for an ephemeral existence. Finally, each is perishable, and 
soon returns to the earth to form the inertia of the inorganic 
world. So that, physically, the intellectual man, the beau- 
tiful woman, the fleet antelope, the sly mouse, the stately 

(17) 



18 GENERAL PATHOLOGY. 

oak, and the humble lichen, are alike formed of the earth's 
material — are alike pensioners upon her bounties — alike 
they have a common fate, dissolution — alike their elements 
are returned to the silent recesses of the inorganic world. 

We may extend this general view of organic life b}^ pre- 
senting other interesting similitudes common to all living 
beings. Each individual organism, whether animal or vege- 
table, is derived from a primordial cell, which consists of a 
vesicle filled with nutritive fluid ; each is developed by nu- 
trition, which is at first carried on in the single primitive 
organic cell; this cell produces its kind, and multiplies into 
successive congeries of cells, until an organism is formed. 
Each organism is supplied with a circulating nutritive fluid ; 
hence, the sap of plants and the white fluid of the mollusk 
answer to the red blood that nourishes man and the lower 
animals. 

This general resemblance is again presented in the re- 
markable similitude between the life of an individual organ- 
ism and the life of a species. Each species, as well as each 
individual, has its time of origin, its embryonic stage, and 
its time of decline. Some of the fossil forms of the early 
geological ages are the embryos of existing species of ani- 
mals. 

Leaving this general view of the resemblance between, 
and the characteristics common to all living organisms, or- 
ganic life next presents to our view a series of individual 
beings, each possessing its own peculiar individuality, prop- 
erties of matter, and conditions of activity. The organic 
series appears to arise from inorganic matter, as by natural 
proneness, and extends from the merest effort at organization 
to an organism most complete and wonderful- — from the 
cryptogamia to the mammalia — from the mushroom to the 
man — from the humblest moss to the most highly organized 
man. 

Organization is not limited in development by the arbi- 
trary classification of species. The classification of organic 



CELL DEVELOPMENT. 19 

bodies into species, is convenient as expressing a general idea 
of their degree of organization, but it is far from definitive. 
It is a common error to suppose that all of any species of 
plants or animals are equal in organization. There are 
various degrees of organization in the human species ; and 
so of all the species of the lower animals and plants. 

Perhaps the most comprehensive view of the organic series 
is presented by supposing a ladder planted at the foot of 
Chimborazo and extending to the summit ; this may be made 
a scale representing the relative organization of all organic 
bodies. Commencing where life and matter meet, in the 
primordial cell of the cryptogamic plant, at the lowest round 
of the ladder, we ascend gradually through the vegetable 
kingdom, and its various botanical classifications, until we 
reach the zoophyte, which is the link that connects vegetable 
with animal organization. It is the round upon which the 
former ends and the latter begins. 

Leaving these zoophytic corals and polyps, we continue 
the ascent through the zoological classifications of the animal 
kingdom. Here we find, successively, the mollusca, the 
articulata, and the mammalia. The highest species of the 
latter order are the human races; of these there are five. 
These races rise successively one above another, in point of 
organization, as species above species, the lowest but a little 
above the highest of the lower animals — the highest being, 
as a class, the most completely developed of all organic 
beings. It is important to observe the effect upon organic 
development of external influences, such as light, heat, 
mental impressions, etc. These influences will be considered 
in the succeeding chapter. 

It is an important fact that every primordial cell presents 
the same precise appearance, whether animal or vegetable. 
If three of these cells be examined by the most experienced 
observer, no perceptible difference can be distinguished be- 
tween them ; each will be a fac simile of the others. Yet, the 
results of their several developments may be far different — 



20 GENERAL PATHOLOGY. 

one may develop a man, another a frog, and the other a fig- 
tree. Thus, by a few variations in the creation and develop- 
ment of a diminutive cell, the living being is a reptile or a 
fowl, a plant or a lion, a leviathan or a man. 

The primordial cell, then, is the point from which all liv- 
ing beings spring ; it is the point at which life and matter 
meet and are united — at which vegetable and animal life 
meet and embrace each other in the harmony of progressive 
development. It is the germ that gives life, form and 
activity to the organic universe — that models every creature 
after its kind — that gives hugeness to the elephant, fleetness 
to the reindeer, strength to the horse, eyes to the eagle, wings 
to the dove — that gives a limited degree of reason (not in- 
stinct) to the lower animals — that links man to all below 
him — that clothes him in the image of the beneficent Maker 
— endows him with the highest degree of reason— prepares 
him for the highest order of life. 

The primal cell was doubtless formed from inorganic ma- 
terial ; but how was it thus formed ? Need we invoke the 
God of nature for a solution of this query ? Manifestly, in- 
exorable law exemplifies nature, and no known power can 
change the laws of matter. Organic cells produce their 
kind; the form and nature of an organism is impressed 
upon the primordial cell by the power that produces it. 
These cells are eminently prolific; a single cell develops 
congeries in rapid succession, until an organism is formed. 
The resulting organism is indicated by the nature of the 
first cell and the influences attending its development. 
Each living being, from the humblest plant to the most 
complex human being, has its precise place in the universe 
established by these influences. Nature never makes a 
mistake — no lapsus naturse can occur; every development 
depends on the influencing circumstances. Hence, a child 
may be born with hare-lip, minus a limb, or it may be 
acephalous ; it would truly be an unnatural child, but its 
development in this form is a natural result of the attendant 



ATTRIBUTES OF MAX. 21 

influences. Nature "cuts no freaks," and is not at fault for 
these imperfect developments ; they are but evidences that 
the operations of nature are conducted upon a general plan 
— that development is liable to mutation from ever-varying 
circumstances. Development, like, nutrition, may be in- 
creased, diminished, or perverted. 

Observe the rudimentary organs, in some animals, as the 
subcutaneous feet of some reptiles. Plants, too, present 
rudimentary organs and excess of development ; a flower is 
a transformed branch — the sepal, the petal and the stamen 
would have been leaves had circumstances been more con- 
ducive to their development. These facts present the import- 
ant corollary that the different forms into which organic 
matter is grouped is neither the effect of Divine special 
interference nor the decree of chance, but it is the inevitable 
consequence of immutable physical law. 

A comprehensive view of nature presents all the forms 
that surround us, both animate and inanimate, the earth, 
and all the hosts of worlds that circle the sun, as the product 
of an original idea, and the subjects of one prime law which 
is co-extensive with space and coeval with the universe. 
Then it is under these laws that the process of development 
is conducted ; and as it is diminished or perverted by adverse 
influences, it is promoted when the influences are conducive. 
Horticulturists promote the growth of plants, and improve 
the quality of fruits by careful culture. Animal develop- 
ment is augmented in a similar manner. Children inherit 
the dispositions and infirmities, and, coordinately, the resem- 
blance and intellect, of their parents. A generation born of 
highly organized and intellectual parents, and brought up 
in cultivated social circles, would bring the millenium. Vast 
and wonderful are the capabilities of man. He is the 
epitome of nature, the acme of the organic universe, the 
noblest sentient organism. He is a material body, capable 
of most exalted reason and morals. He exercises an appre- 
ciative discrimination between right and wrong, between 



22 GENERAL PATHOLOGY. 

good and evil. He possesses a principle — a moral nature — 
a living monad, which impels him to seek the reward of 
virtue and to evade the punishment of vice. He is the 
architect of his own destiny. He posesses power to act and 
a will to direct his own actions, and he is responsible for the 
manner in which he does act ; but some of his actions are 
necessitated ; for these he is not responsible. 

Man's moral nature, exalted as it is, is not his only enno- 
bling attribute; he is capable of a degree of intellection, 
investigative reason, and methodical thought, which exalt 
him far above all organic beings. But for these faculties of 
man, the moral world would be a chaos — the earth would 
yet wear her primal dress — the ocean would forever defy 
navigation — our rivers had never been whitened with the 
sails of commerce — the earth would continue her circuit 
without her motion being observed or admired — the blood 
would course our veins, and nutrition and oxygenation 
would go on without being observed — steam would have 
forever moved on with, and existed in, the rushing billows 
— the lightning would have roamed untamed in the ele- 
ments — the universal law that regulates life and matter, 
that controls the stars and holds the planets in their orbits, 
would have continued its ceaseless operations unrecognized 
and unadmired. 

Insignificant indeed would be man without the guidance 
and power of exalting mind. Muscle is to brain as matter 
is to mind. Muscular contractions can but procure the daily 
bread ; mental power elevates individuals, communities, and 
nations. Physical power is brute force ; knowledge is power 
— real, effective, and supreme. 

The noblest intellect and the highest virtue are united in 
man — sentient and moral, intellectual and responsible man. 
He alone is biped and bimanus. He alone possesses a per- 
fect vertebral column. He alone supplicates the shrine of 
science — investigates the laws to which he is subject, both 
physical and mental — moves erect — is lord of earth — having 



ATTRIBUTES OF MAN. 23 

no peer, he moves the paragon of the organic world. Though 
he comes into the world the most helpless of all animals, his 
feeble arm chains the mighty lion ; and the horse, the ox, 
and the elephant, move at his bidding. Armed with the 
front of Jove, the power of intellect, the light of reason, and 
the torch of discovery, he scans the universe — makes all 
below him subservient to his will. He disarms thunder, 
and sends the lightning on errands, along the wire path. 
The earth rejoices in his presence, allures his taste with 
viands, and perfumes him with her fragrance. Morpheus 
guards his slumbers. Distant worlds send luminous beams 
to relieve the monotony of his nocturnal soliloquies. 



24 GENERAL PATHOLOGY. 



CHAPTER II 



CONDITIONS OF FORM AND ACTIVITY OF MATTER. 

Man is not exempt from the laws of matter. It would be 
inexcusable error to suppose that the form of even inorganic 
matter is the result of chance. The irregularities of the 
earth's surface depend upon laws as purely physical as those 
which hold the planets in their orbits. The mountains' lofty 
peaks and descending slopes are marked by the ravages of 
time, and by the physical impress of the number of beating 
storms they have withstood. The desert - of Sahara tells 
of the burning rays of an equatorial sun — the sands of the 
beach and the rock of Gibraltar are marked by the ever- 
recurring ocean wave. 

Rising to the organic universe, we find the same inexora- 
ble law prevailing throughout; it modifies the form and 
regulates the activity of all organic bodies. Plants do not 
spring up indigenously as under the irregularities of Todd's 
fabled chance world, but their growth and distribution are 
influenced by light and heat derived from the rays of the 
sun ; also, by the quality of the soil and the amount of 
carbonic acid gas in the atmosphere. That these influences 
direct the growth and variety of plants is abundantly 
demonstrated. If we travel from the equator toward either 
pole, we find each hemisphere belted with zones precisely 
corresponding in the nature and variety of their vegetable 
productions. Corresponding zones of vegetable growth are 
observed in ascending from the base to the summit of a 
mountain of sufficient altitude to present the same variations 



CONDITIONS OF FORM AND ACTIVITY OF MATTER. 25 

of temperature and climate as the different latitudes of the 
earth's surface. 

Light, heat and moisture are essential conditions of vege- 
table growth. A seed would never germinate in the absence 
of these conditions ; but if it be introduced into a soil where 
there is sufficient warmth and moisture, it will germinate ; 
the young plant, being fed and nurtured by the nutriment 
stored up in the germinal seed, will rise above the ground 
before this supply is exhausted, but it cannot long survive 
without the presence of light ; there will be tardy and im- 
perfect development owing to lesion of nutrition ; instead of 
being green the plant will be colorless, in consequence of 
the absence of chlorophyl, which is imparted to plants only 
through the agency of light. 

Moisture promotes the growth of plants by supplying their 
roots with carbonic acid gas, which diminishes the amount 
that the leaves are required to take in from the atmosphere. 
Rain facilitates the development of plants by allowing them 
to appropriate to their own tissues the saline constituents of 
the soil in which they grow. 

Besides these physical conditions, it is important to observe 
the variable influences produced upon plants by the various 
chemical constituents of the soil. The tobacco-plant requires 
a large amount of nitrate of potash ; the lime-plant requires 
abundance of lime earth. High dry lands contain largely 
of oxygen ; low damp lands abound in hydrogen and 
nitrogen ; and consequently in ammonia. 

From the foregoing considerations, it is conclusive that the 
various forms of inorganic bodies are directed by the univer- 
sal law of cause and effect ; and that though there exists in 
the germs from which vegetable organisms spring an inher- 
ent predisposition to develop into certain definite forms, yet 
their activity and degree of development are dependent 
upon numerous conditions, which are so many operations of 
physical law ; so that vegetable and inorganic forms are alike 
determined by the binding force of philosophical laws. 
3 



26 GENERAL PATHOLOGY. 

Further, what is true of these is also true of the animal 
organism, including man. Medical men, though leading the 
way in scientific research, were slow to discover that all 
matter is governed by one stupendous law. It is in con- 
formance with this law that the universe is governed ; that 
the world "wags" as it does; that material bodies have form, 
affinity, attraction and gravitation ; that organic as well as 
inorganic bodies possess these properties; that the sap 
nourishes the tender leaflet ; that the blood courses the veins 
and ramifies the minutest capillaries ; that organic activity 
is maintained at a standard of health ; that disease originates 
and produces death, and that it subsides either with or 
without the aid of medicine. 

It is unfortunate for science that most of the obscure phe- 
nomena of organic activity were so long considered as "vital 
power," which was understood to be the result of divine fate, 
or the fiat of some god in Pagan mythology. 

The animal mechanism now claims our special attention. 
It is designed for activity on a huge scale, and is constructed 
in precise adaptation to the nature of the influences that put 
it in motion and continue its action. Besides, each animal 
is constructed in perfect adaptation to its mode of life ; hence, 
the fish has fins, the fowl has wings, the ruminant animals 
are provided with facilities for easy locomotion or transition 
to enable them to go in search of food. Man is favored 
above all, with legs to walk, hands to labor, and a brain to 
exercise a high order of reason. The lower animals, too, 
are capable of a degree of reason, in direct proportion to the 
amount and quality of their cerebral matter. That the lower 
animals possess this capability, has been denied by almost 
all writers on metaphysics ; but it is affirmed by observing 
the docility of the horse, the dog, and the elephant ; and it is 
asserted by the great fundamental law of cause and effect, 
of structure and activity, of mind and matter. 

All animals live upon a descending scale ; their activity 
necessitates disintegration of their substance ; they suffer a 



CONDITIONS OF FORM AND ACTIVITY OF MATTER. 27 

continual retrograde metamorphosis, by which they tend to 
decay, and return to their inorganic elements. They do not 
possess the capability of opposing any resistance to this con- 
tinual wasting, but provision is made to compensate for it 
by the process of nutrition. The preceding remarks apply 
alike to all animal organisms, and, in a general sense, to 
plants as well. From the foregoing are derived the following 
considerations, which apply in a special sense to the human 
organism. 

We cannot contemplate the wonderful design of the hu- 
man mechanism without feelings of deepest wonder at its 
sublimity and excellence, nor without emotions of reveren- 
tial esteem for the Designer. And when we consider the 
completeness of this organism — the structure, adaptation and 
properties of its various parts fitting it for the performance 
of the various functions — essential not only to its existence 
and preservation, but to the highest order of life and activ- 
ity — the wonder becomes amazement. But wonder ceases 
as Physiology advances. Under the behest of the universal 
laws of matter, and the properties with which our various 
tissues and organs are endowed, it is natural for all the func- 
tions of life to be carried on as they are in health, and in the 
presence of their essential conditions of activity ; so when 
any part of its structure suffers lesion, it is natural for the 
action to be correspondingly changed. The life of the 
organism depends upon the ceaseless activity of its various 
parts, especially of the heart, lungs, and brain, which are 
the tripod of life. The activity of each organ depends upon 
one or more conditions ; thus, the motive power of the heart 
evidently depends upon the direct presence of oxygenized 
blood, and the stimulus which it imparts to the minute gan- 
glia of sympathetic nerves. The heart, instead of being the 
seat of mental emotions, as was once supposed, is a muscle 
constructed into a hydraulic apparatus. Its left ventricle 
contracts with a force sufficient to raise a weight of thirteen 
pounds, and may perform three thousand millions of such 



28 GENERAL PATHOLOGY. 

contractions during the life of an individual. The essential 
condition of the activity of the lungs is a due supply of at- 
mospheric air, which is required for the oxygenation of the 
blood ; and upon this condition of the blood depends all the 
activity of the brain and nerves, and upon these depend 
mainly all muscular and glandular action. So that, by an 
easy transition of methodical thought, I conclude that all 
organic activity depends essentially upon the quantity and 
quality of the blood. Besides, certain organs and parts require 
special external influences to excite their latent functions into 
activity ; thus, the eye perceives nothing in darkness ; the 
optic nerve requires light as an essential condition of its activ- 
ity. The optical mechanism, and the accessory apparatus of 
the eye, elicit our admiration of the wisdom and perfection 
of the design. The retina is formed by an expansion of the 
distal extremity of the optic nerve. The impression of light 
is received by it, and by the aid of the black pigment, which 
serves as a screen, to prevent the rays of light from straying, 
and by the shade of its color the image is formed. The 
ciliary muscle adjusts the lens according to the distance at 
which objects are viewed, by diminishing the convexity of 
the cornea in proportion as the distance is greater. The iris 
determines the color of the eye according to the color of the 
pigment on its posterior surface, but its essential function is 
to regulate the rays of light that are allowed to pass on to 
the retina ; it is stimulated to contract in direct proportion 
to the intensity of light, and immediately dilates as the light 
is removed. 

The auditory nerve requires the vibration of sound as a 
condition of its activity. The mechanism of the ear is well 
adapted to impart to our senses the vibrations of sound ; not 
only so, but it affords us an accurate idea of external rela- 
tions by enabling us to distinguish the peculiarities of sound. 
In order to enable us to discriminate between the different 
characters of sound, the ear is supplied with a tympanum to 
determine the intensity, a cochlea to measure the length of 



CONDITIONS OP FORM AND ACTIVITY OF MATTER. 29 

the wave or note, and canals which inform us of the quality 
of sound. The scalse are designed to prevent continuous re- 
verberations, by destroying the wave as soon as it has filled 
its mission ; but for their interference, an ordinary vibration 
of sound would continue to revibrate for an indefinite period 
of time; besides, every sound of ordinary intensity would, 
perhaps, do violence to the brain. The great intensity of 
sound produced by the heavy cannonading in our late war 
did serious damage to the auditory apparatus and brain of 
many cannoniers. 

The eye and ear, though essential to our convenience and 
happiness, are not essential to life ; but, like them, all organic 
activity essential to life depends upon conditions. Manifestly, 
in the construction of man oxygen was designed as the 
prime and essential condition of his organic activity. The 
foetus in utero is supplied with oxygen from the arterial 
blood of the mother by means of a very curious design in 
the uterine surface of the placenta. When detached from 
the mother, it can survive but a few moments upon the small* 
amount of oxygen it receives through the skin ; therefore, 
oxygen is the first thing demanded in its independent life. 
The external impressions produced by the new world, or by 
some specially directed agent, upon the peripheral extremity 
of the excito-motory nerves, cause the lungs to expand and 
receive oxygen into the blood ; and this oxygenized blood 
supplies the brain, and through it every member of the 
system with its essential condition of activity. 

This subject is eminently suggestive : each idea presents 
another still more instructive — each successive truth is but 
the herald of the abounding treasures that invite us onward. 

There would be no organic activity without an external 
primitive agency or influence to awaken it through an 
essential condition. Activity is conditional — life implies 
activity ; activity implies waste, or death of tissue. Hence, 
the condition of life is death. Ominous truth, proclaimed 
by the laws of life, and attested by the laws of matter. Man 



30 GENERAL PATHOLOGY. 

is a taper — always forming, always dying. In order to form 
a just conception of the rapidity of our interstitial death, it is 
important to observe that for every contraction of the heart 
about twenty millions of blood-cells die ! 

The more active an organ, the more rapid its death. 
When the brain is actively engaged in thought, the waste of 
its substance is correspondingly increased . Nervous material 
contains largely of phosphorus ; its proportion in the brain 
is from 8 to 35 parts in 1,000. As the relative proportion of 
phosphorus in the brain has been observed to increase 
during adolesence, and to diminish with declining years, it 
has been supposed that its proportion stands in definite 
relation to the degree of intellect, and accordingly that 18 
parts in 1,000 indicates an average intellect. Doubtless this 
view should be received with some allowance ; yet it is a fact, 
significantly corroborative, that the brain of idiots contains 
a very low relative proportion of phosphorus. The phos- 
phorus in the brain is in an unoxydized state, but it is 
rapidly oxydized by the increased amount of arterial blood 
distributed to the brain during excessive mental labor ; 
hence, the waste material of the brain is mainly in the 
form of phosphates, which are excreted by the kidneys 
and skin. 

Muscular activity is attended with excessive waste; great 
physical exertion is, most of all activity, destructive to tissue. 
The resulting waste is mainly in the form of urea, which is 
taken into the torrent of the circulation, and hurried out of 
the system by both the kidneys and the sudoriparous glands. 
The fats are exceedingly combustible ; after undergoing 
oxydation they are excreted in the form of carbonic acid gas 
and water. The waste material of the walls of the capillaries 
passes from the system through the kidneys in the form of 
ammonia. When the protean constituents of the food are 
carried into the blood in greater abundance than is necessary 
for the growth or repair of the system, the excess is cast out 
in the form of urea and uric acid. It follows, accordingly. 



CONDITIONS OF FORM AND ACTIVITY OF MATTER. 31 

that adults lose daily about five pounds of tissue by disin- 
tegration. 

In order to compensate for this continual retrograde meta- 
morphosis, the system must be supplied with oxygen, water, 
and combustible material. Each of these possess chemical 
affinities for the others, which give rise to all the physical 
phenomena of life. Oxygen is everywhere present in the 
surrounding atmosphere, and is the prime condition of motive 
power. It is essential to the production of animal heat, and 
to the combustion of material preparatory to its disintegra- 
tion. 

Water is furnished to the system in great abundance in 
the food and drink. By its evaporation it becomes a refrig- 
erent, and prevents the continual combustion from generat- 
ing too great an intensity of heat. Besides, it attenuates the 
blood, and promotes the absorption and solution of waste 
materials preparatory to their excretion ; and as well, by its 
solvent power, it presents in a fluid state such nutritive 
materials as are required for assimilation and repair. 

Combustible material is furnished to the system in the 
form of food. It is essential to man that the food be com- 
posed of a mixture of animal and vegetable substances ; that 
it be sufficiently calorifacient to insure the requisite degree 
of oxydation and heat, and that it be sufficiently histogenetic 
to furnish to the blood all the materials necessary to build 
up the decaying tissues. 

Then the inorganic world furnishes our food and our 
material substance, by entering into such combinations and 
relations as form vegetable and animal substances, and, 
finally, that of material man. These considerations startle 
us with a view of our immediate proximity to the inorganic 
world. Viewed in any direction, but one material meets the 
eye and bounds the vision — on either hand the fearful preci- 
pice presents. We are continually receiving from the inor- 
ganic world new supplies of material matter — we are con- 
tinually dissolving into our inorganic elements. 



32 GENERAL PATHOLOGY. 

The blood carries to all parts of the system the plastic 
material necessary for repair. The assimilation of these 
plastic elements by the various parts to meet their several 
demands, in kind and quantity, appears to be influenced by 
something like elective affinity. A similar affinity is pre- 
sented in the action of medicines; hence, we have chola- 
gogues, diuretics and hypnotics. 

Connected with the reparative process is observed a 
friendly provision for the transference from one part of the 
system to another of material necessary to the reconstruction 
of the part ; accordingly, a large amount of phosphate of 
lime is transferred to every part where ossification and 
reconstruction of osseous tissues is progressing ; by a similar 
special provision, chloride of soda is transferred from all 
parts of the system to the vicinity of an inflamed part. In 
like manner fats are stored away in the system, and held in 
reserve to meet future demands.. 

The aggregate amount of ingesta which man receives daily 
is about one-fourteenth part of the weight of his body. It 
is estimated that he receives diurnally, of water four pounds, 
of oxygen two and one-half pounds, and of food two and 
one-half pounds ; so that he consumes annually about a ton 
and a half of these materials. These, together with a series 
of ever-varying physical relations and conditions, as light 
and atmospheric relations, give form and activity to man. 
As all these conditions of nutrition, development and life 
vary, so in precise ratio will the resulting form vary ; and as 
the form varies, so will the faculties and mode of action. 

To live is to change. Our changes begin with the fecun- 
dation of the ovum, and cease when our last corporeal tene- 
ment is dissolved. We do not possess the same entire body 
a moment. We hold our indentity in consequence of con- 
tinual change of our material substance, which is but a com- 
bination of inorganic elements in ceaseless change and rapid 
transit, and deriving activity from essential relations and 
conditions. Our changes are directed by our varied relations 



CONDITIONS OF FORM AND ACTIVITY OF MATTER. 66 

to the physical world and by the operations of physical law. 
Individual peculiarities of type, or the predisposition of a 
primordial cell to develop into a prescribed definite form, is 
as subservient to the modifying influences of general laws 
as are the types of disease to individual peculiarities of con- 
stitution. That "circumstances govern cases" is an adage 
as true as it is antiquated, and it has a special importance 
when applied to the human organism. A dose of medicine, 
judiciously prescribed and timely administered, may save 
life ; if injudiciously or untimely, it may produce death. An 
untimely mess of fried eggs, or cabbage, may produce death 
as surely and quickly as an overdose of arsenic or strychnine. 
A morsel of beef taken into the system effects a change, 
though not perceptible, yet as real as that produced by a 
grain of morphine. 

The careering rain storm and the chilling blast affect, in 
some degree, all matter within their range. Physical influ- 
ences produce the cliffs on the western shores of rivers and 
the low lands on their eastern borders. Excluded from light, 
a plant can maintain but a brief aerial life, and that under 
a very imperfect development. In the absence of this one 
physical agent, a tadpole would never become a frog. An 
infant exposed to perpetual darkness would be imperfectly 
developed and short-lived, and would with almost absolute 
certainty be the subject of imbecility of both body and 
intellect. The inhabitants of the dark gorges of Switzerland, 
and the valleys of the Alps, present numerous examples of 
extreme idiotcy and frightful cretinism. 



34 GENERAL PATHOLOGY. 



CHAPTER III. 

COMPARATIVE VIEW OF PHYSIOLOGY AND PATHOLOGY. 

Man is almost isomeric with the Andes. He is an infini- 
tesimal integer of the material world — an atom of inorganic 
matter vitalized — and yet, in image, he is the prototype of 
the Creator. By organization, adaptation, and mechanism, he 
is a microcosm. He is preeminently endowed with the at- 
tributes of sensation, mobility, and intellectuality. His 
matchless system of organs and their wonderful adaptation 
endow him with the highest degree of animal organization 
and adapt him to the highest order of life. Further, each 
organ and part of this complex organism is assigned definite 
functions, and all act in harmonious concert according to 
fixed laws of nature. This is health. That science which 
investigates these laws is called Physiology. 

A structure so complex, having so many combinations and 
peculiar modifications as the human organism, is very liable 
to suffer lesion in some of its parts. The consequence of this 
lesion is a corresponding disturbance of the functions of the 
organ or organs involved. This lesion of the structure, how- 
ever slight it may be, is disease; and the disturbance or 
change of functions which it produces are symptoms. That 
science which investigates the diseased organism — which 
enables us to determine the location, character, and cause of 
the lesion — is called Pathology. 

So far we have presented Physiology and Pathology, each 
in its distinct and legitimate domain, but we often have to 
deal with both conjointly; they flow together so intimately 
that it is often difficult to determine whether a given propo- 
sition belongs to the province of the one or the other. 



COMPARATIVE VIEW OF PHYSIOLOGY & PATHOLOGY. 35 

Pathology comprehends all there is of Physiology. It is the 
province of the latter to investigate normal functions ; of the 
former, to investigate abnormal structure and the consequent 
change of functions. There is no obvious reason for this 
seemingly arbitrary division of the science which investigates 
organic life. I maintain that the human organism, with its 
complex system of organs, is per se as automatic as a steam 
engine ; that it is, by reason of its vital properties, capable of 
receiving external impressions, but it possesses no inherent 
or vital power to put itself in motion ; that the conditions of 
its activity require external causation ; that no organ in the 
system would act without its proper stimulus. Thus, the 
eye would be useless without light ; the auditory nerve would 
forever be dormant if not awakened by the vibrations of 
sound; the impulse of the heart depends upon the condition 
of an appropriate stimulus; the brain refuses to act without 
the presence of oxygenized blood. Further, each organ in 
the system acts as it is acted upon; their action is increased, 
diminished, or perverted, in precise correspondence with 
every change of the agency which influences their activity. 
We behold with profound admiration the wonderful adapta- 
tion manifest in all the phenomena of organic life. This is 
exemplified in the highest degree in man's organism; he 
conveniently satisfies one essential condition of his existence 
by inhaling, from the surrounding atmosphere, oxygen 
properly diluted with nitrogen. He receives as food all the 
materials necessary to compensate for the continual disin- 
tegration of his structure, and to reconstruct when tissue has 
been destroyed by causality. He possesses facilities for cast- 
ing out effete and deleterious substances, and for protecting 
the system against pestilential influences from without. 
This is the vis medicatrix naturse; it is but the protection 
which the system derives from the friendly agency of some 
of its parts. The ample provisions with which we are sup- 
plied for existence, health, and comfort, are, after all, not so 
wonderful in themselves. It is not astonishing that all the 



36 GENERAL PATHOLOGY. 

organs and parts do their office according to conditions and 
apparent design ; but the structure, mechanism and adapta- 
tion of the organism, and its various organs and parts, are 
truly wonderful. It is a subject of wonder that the heavenly 
bodies were formed, placed in their respective orbits, and 
laws instituted capable of regulating their motions; but 
when these laws are understood, the movements of these 
bodies are neither strange nor unnatural. It would only be 
strange if those luminous worlds were to refuse obedience to 
the mandatory law; rather would it excite wonder if our 
Earth were to lose her centrifugal force and fall to the Sun, 
or if Jupiter were to lose his centripetal force and move into 
infinitude. 

From abundant evidence, of which the foregoing is but a 
tithe, I conclude that no organic body is exempt from the 
laws of matter ; that the impulse of the heart, as well as the 
earthquake that rocks kingdoms, is but the legitimate effect 
of an efficient cause; that of the various organs of an or- 
ganic system, each acts according to laws which are fixed 
and harmonious; that, therefore, these actions are necessi- 
tated by the force of physical law. Organic activity furnishes 
a series of unvarying examples of the laws of cause and effect. 
A mechanism so complex, possessing so many delicate 
structures and presenting so much relative dependency of 
its various parts as the human organism, is of necessity 
in the highest degree impressible to the slightest disturb- 
ing influences; such influences are numerous and their 
effects upon the system are incessant, though perhaps gener- 
ally in so small a degree as not to attract notice. It is not 
until one or more of these influences acts with sufficient 
intensity to produce notable lesion that the name disease at- 
tains ; here, too, is presumed to be the dividing line between 
Physiology and Pathology. Now I maintain the proposition 
that each organ and part is essentially active to the restraints 
of physical law, and that they have no more power to evade 
it than Jupiter has to quit his orbit and visit Mars. As all 



COMPARATIVE VIEW OP PHYSIOLOGY & PATHOLOGY. 37 

organic activity is influenced by primitive external cause, 
the degree and manner of action are as definitely indicated 
by condition and cause as effect is indicated by cause on the 
principles of natural philosophy. 

An organ cannot act abnormally ; it is natural for every 
organ to act precisely as it is permitted or influenced to act, 
and so all organs do act. We may appropriately speak of 
abnormal structure, but abnormal action is clearly a mis- 
nomer. To illustrate — if there is irritation in the brain, no 
matter how produced, it is natural for the following effects 
to be produced in rapid succession : local hyperemia, in- 
creased oxydation, exudation, and so on, through all the 
stages and results of inflammation. Here each effect is an 
additional cause of the progressive activity ; and further, the 
activity, perversion or demolition of the legitimate functions 
are in precise ratio with the mutations of the conditions on 
which these functions depend. Here, then, is a morbid 
process progressing naturally, for it is a series of natural 
causes and effects. To assert the converse, would be equiva- 
lent to saying that effect can exist without a cause. But it 
may be asserted that these are abnormal actions, inasmuch 
as they are the effect of an influencing cause ; then I answer, 
so is all organic action the effect of causation, as abundant 
proof has been presented to establish. 

General Pathology, then, as well as Physiology, is an 
investigation into the conditions of activity, its causes and 
its effects, both direct and remote, and the design and relative 
dependency of the several organs and parts of the system. 
Pursued in this light, pathological investigations, instead of 
being embarrassed by mystery, will present in extenso the 
pleasing and comprehensive conditions of the laws of life. 
Every cause has its effect, every proposition has its solution 
either within the limits of our knowledge, or incognito. If a 
heavy blow on the head is followed by coma, we say there is 
pressure, because we know it is natural for pressure to 
produce coma ; and the solution is as easy inversely : given 



38 GENERAL PATHOLOGY. 

pressure on the brain, we foretell that coma is a result. The 
kidneys may be deprived of their conditions of activity, their 
functions are instantly suspended ; there is ischuria, urea is 
permitted to increase in the blood until it becomes an over- 
dose to the brain — coma ensues — the individual is poisoned, 
not by the doctor's drugs, but by a narcotic poison generated 
in the system. Again, the system contains largely of phos- 
phate of lime ; it forms mainly the enamel and osseous tissue. 
In pregnancy, this constituent of the mother is diminished 
because it is drawn largely upon for the organization of the 
child. This diminution obviously affects the osseous tissue 
of the mother ; her bones become more soft and yielding, 
and less friable. They are not so easily broken ; but if she 
does suffer fracture of a bone, its union will be slow for 
obvious reasons. 

But pregnancy furnishes another interesting series of 
causes and effects. The pregnant woman necessarily con- 
sumes more than her usual amount of oxygen ; hence, the 
proportion of fibrin in her blood is increased : some of this 
may be albuminous, or, from any cause, may possess a low 
form of plasticity, or be incapable of organization ; and, if 
deposited in the lungs or other textures, it may form tubercle. 
It has several times occurred to the author, to see women 
having no well marked hereditary predisposition die of 
tubercle originating in this way ; and so we might continue 
the utilitarian revelations of Pathology to an extent almost 
ad infinitum. 

The special facts and general principles drawn from the 
dominions of Physiology and Pathology are to the physician 
the nuclei of knowledge, the accessible avenues to skill, and 
the light of the way. If the leading general principles were 
well understood, isolated cases would explain themselves ; 
but there is a fatal omission in this ; special pathology is 
grasped after with eager greed, and, of course, is to such 
devotees as dark as Virgil would be to a Hindoo. Hence, 
the medical press is encumbered with a profusion of unim- 



COMPARATIVE VIEW OF PHYSIOLOGY & PATHOLOGY. 39 

portant details of special cases which have an easy solution 
originating in first truths; they are only remarkable as 
evincing the steadfastness of Nature's laws — they would be 
wonderful were they otherwise. True, Nature has not yet 
revealed all her mysteries to the oracles of Science, but we 
should search for them at the fountain of Pierian lore. 

The writer has never appeared before the profession as a 
chronicler of the wonders which have occurred to him in 
practice, nor of the strange phenomena which well-defined 
disease has presented ; these are as natural, under the cir- 
cumstances producing them, as volition, secretion and sleep 
are in health. So it is natural for fever to suppress secre- 
tions, for a clot or tumor in the brain to produce palsy, and 
for lesion of the cerebrum to dethrone reason. 

These views are believed to be sustained by all that is 
known of Physiology and Pathology ; they clearly harmonize 
with the conditions of our organization, with our relation 
to surrounding objects, and with the laws of life. But the 
end of research is not here ; momentus questions continue 
to present themselves. 

What is the rationale of the diminution or the absence of 
chlorides in the urine during the progress of inflammation ? 
It is well established that the presence of an abundant supply 
of the chlorides is an essential condition of every rapid 
development by cell growth ; hence, large amounts of the 
chlorides are present in the development of the foetus ; and 
in every inflammation, or process of exudation necessitating 
cell-growth, the chlorides are withdrawn from the blood and 
urine and collected at the scene of lesion. Heretofore, the 
general principles explanatory of this change in the amount 
of chlorides in the urine during inflammation have attracted 
the attention of but few pathologists. But it has been noticed 
mainly during inflammation of special organs — of the lungs, 
we may accurately determine the advance and decline of 
pneumonia by daily observing the presence or absence of 
the chloride of soda in the urine ; if the disease is severe 



40 GENERAL PATHOLOGY. 

and progressing, the chlorides are absent ; their re-appearance 
or increase warrants a favorable prognosis. The test is made 
by pouring a small quantity of sol. argent, nit. into a test 
tube or vial containing a portion of urine, then add a drop 
of nitric acid ; if chloride of sodium is present, it will be 
precipitated in a whitish cloud-like sediment. 

The toxic action of mercury upon the system deserves 
some notice, en passant, as distinct from its remedial virtues. 
Manifestly, the declining practice of introducing mercury 
into the system, to vitiate the nutritive plasma of the blood, 
arrest nutrition, destroy living tissue, and produce lasting 
cachexia, is a fateful error ; and is only sustained by a theory 
as fallacious as that which impels the Hottentot mothers to 
present their infant children as oblations to the watery gods. 

The industrious and scrupulous investigator of the work- 
ings of the human organism in health and in disease will find 
error depicted on the pages of many of our standard works, 
even of recent origin. Our profession has been called the 
most learned known to man, and so it doubtless is ; surely 
it comprises the greatest body of the most learned men on 
earth. But, it is repugnant to the feelings to take a retros- 
pect of the deplorable doctrines and destructive practices of 
the darker ages. The ruthless car of empiricism, as a besom 
of destruction, swept over the land, consigning the hale to 
valetudinarianism, and the afflicted as oblations to the 
common mausoleum of former generations. But a brighter 
day has dawned. Investigations having been directed in 
the right channel {id est, to physiology, pathology and 
chemistry), Nature unfolded the mystic woof, and shed a 
halo of light around her successful votaries. 

Although much yet remains in the form of hypothesis, to 
be verified by careful and continued research — and more, 
perhaps, to be dreamed of — yet we are encouraged to see the 
mist of puerile conjecture give way before the light of reason 
as the fog recedes from the light of the blazing sun. I revere 
those zealous-hearted and clear-headed votaries to the truths 



COMPARATIVE VIEW OF PHYSIOLOGY & PATHOLOGY. 41 

of Nature's abstruse laws, whether of the present generation 
or of days of yore, whose researches have contibuted to 
expand the domain of pathology. Chemistry has rendered 
material aid to the rational practice of medicine, particularly 
in those forms of disease which are to be encountered and 
conquered by the action of direct specific antidotes. 

If, while following blind empiricism for six thousand years, 
chance discovered the remedial virtues of some of our most 
valued drugs, then we are by an easy transition of thought 
led to conclude that those great results of popular observa- 
tion will be more than equalled each year by the positive 
and veritable results of rational pathology. Think for a 
moment of the highly utilitarian extent to which pathology 
has already been carried— of the irrational diagnosis and 
injurious treatment which are every day giving way under its 
auspices. Think back a few years, and see how many died 
of the lancet ; of mercury ; of antimony. How many have 
died for want of a sufficiency of cold water to attenuate their 
blood, and to wash out the materies morbi by the emunc- 
tories ; and, again, how many have died mainly of inanition. 
All died of the rashness and intolerance of their misguided 
advisers. 

Look at the limited knowledge physicians possessed of the 
essential character of disease. You have seen them calling 
symptoms disease, and treating % them alike irrationally, till 
the patient died of the disease and the treatment — or got 
well in spite of both of them. You have seen the profession 
bleed, blister and purge their patients for endo-carditis ; thus 
compromising the conservative powers of nature — all with 
extremely doubtful propriety, as dilatation of the nutrient 
vessels supplying a part is an essential precedent to the ex- 
istence of inflammation ; and as the membrane lining the 
heart has no vassa vassorum, it is not clear that such disease 
could exist, the valvular murmur being induced by deposits 
of fibrin on the valves of the heart. The vegetation found 
on the valves are very evidently mere deposits of fibrin from 
4 



42 GENERAL PATHOLOGY. 

the circulating arterial blood, and not the product of inflam- 
mation. See them bleeding their patients repeatedly and 
copiously, to destroy the fibrin; but the more they bleed, 
the greater the proportion of fibrin left in the system, See 
them bleeding pregnant women for neuralgic pains, or 
merely because they were incincta. And the "neighborhood 
bleeder" had to bleed every pregnant woman in his vicin- 
ity ; and the doctors looked wise, and nodded assent. See them 
treating typhoid fever and scarlatina, mainly with mercury 
— collapsing their pneumonic patients with veratrurn and 
antimony — making patients run the gauntlet of ptyalism, 
thus adding much to the sufferings and hazard of the pa- 
tient, just because their empiricism told them it was right. 
But I need not dwell longer upon errors which pathology 
renders obvious to us. 

Among the positive teachings of pathology, we find the 
accoucher's eclampsia often depending upon retained urea; 
the autumnal fevers, on retained hydro-carbons ; cancer, on 
living germs deposited from the blood; rheumatism, on a 
redundancy of uric and lithic acid in the system ; stomatitis 
materna, on inflammation or ulceration in the os uteri or 
vagina — sometimes in the bowels. Psoas abscess is now 
known to be as indicative of the strumous diathesis as is 
phthisis pulmonalis. If in a strumous subject tuberculous 
matter form and baccili congregate in a gland, bone, muscle, 
joint, or lung, the essential element of disease is the same in 
all. Local lesions vaguely called white swelling, morbus cox- 
algia, bone erysipelas as well as strumous abscess of a sub- 
maxillary gland, are identical in kind and different only in 
location from tubercle of the lung. But I cannot couch the 
manifold utilitarian revelations of pathology in this chapter, 
or even hint at all its instructive bearings in the rational 
diagnosis and treatment of disease. 

This science having shorn our profession of so many de- 
structive evils, and having contributed so much to establish 
the practice on a rational basis, in but little more than a 



COMPARATIVE VIEW OF PHYSIOLOGY & PATHOLOGY. 43 

quarter of a century, we may a priori expect to be delighted 
and instructed at every step of our progress, as we solve the 
abstruse problems of this hitherto sealed book of nature. At 
every turn of the subject, and in every fresh illustration 
which it reveals to us, we derive more steadfast conviction 
of the total absence of chance or irregularity, even in the 
strangest influences of disease ; we become habitual observ- 
ers of the mystery which tends to preeminently enlighten 
and to elevate the mind — observers of the immutable uni- 
formity which prevails in the observations of nature's laws! 
Who would wonder if ere long the whole secret and charac- 
ter of the most obstinate diatheses will be understood — and 
cancer, phthisis and epilepsy yield as readily to treatment, 
as do now remittents and urticaria? Things not less mar- 
vellous have already come to pass ; and so it may be that we 
shall witness this triumph in our profession. 

Already pathological research has vastly lowered the death 
rate of puerperal and typhoid fevers ; it has brought a flood 
of light and a boon of relief to the protean ills iDeculiar to 
women. May be, if we can learn how to destroy bacteria 
without injuring the patient, we shall yet fully control 
diphtheria and scarlatina. 

Every intelligent physician will readily agree that a man 
is a physician just in proportion as he is a pathologist. It 
is well known that almost the entire amount of valuable in- 
formation we have of the healing art is derived from the 
professional sciences, and not from blind empiricism. It is 
known, that, to an uneducated observer, the workings of a 
diseased organism is inexplicable and uninstructive ; nor in- 
deed can it be otherwise, as philosophers are not made by 
mere intuition, nor astronomers by viewing the heavens 
with the natural eye. Those who would get experience in 
medicine must first get medical science and common sense, 
as these are absolutely indispensable requisites to the acqui- 
sition of experience. 



44 GENERAL PATHOLOGY. 



CHAPTER IV. 

ETIOLOGY — THE CAUSES OF DISEASE. 

Disease is protean, and its causes are numerous; they 
abound in the food, in the air, and in all our relations with 
the physical world. Causes of disease embrace all influences 
and agencies capable of notably changing- the quantity or 
the quality of the blood. Most of the causes act primarily 
upon the blood, as the excess or insufficiency of food, and the 
aerial contaminations, such as the mephitic gases and the 
miasmata, including the effluvia emanating from the bodies 
of those who are laboring under infectious diseases. Other 
morbific agencies and influences, however, act primarily on 
the solids, as mechanical violence, intense cold, and sudden 
mental emotions; the irritant poisons act coincidently on 
the fluids and solids. 

Pathologists have instituted various divisions and classifi- 
cations of the causes capable of producing disease; such 
classifications are more conventional than useful, and are 
far from being satisfactory; indeed disease itself has been 
included in most of those lists of causes. 

Morbific agencies may be generated within the system, as 
the retention of an overabundance of urea, lithic acid, the 
hydro-carbons, and other deleterious excretions; but of these 
intrinsic causes of disease there are but comparatively few ; 
those above enumerated are the most obvious examples, and 
in strictness it is even questionable whether they themselves 
are not the result of external agency. 

It is remarkable that a pathologist no less eminent than 
Prof. C. J. B. Williams mentions excess or defeat of some 
function ("such as irritability"), or of some constituent of 



THE CAUSES OF DISEASE. 45 

the body ("as the blood"), as examples of intrinsic causes 
of disease. Clearly, there is total absence of evidence that 
these examples are primary causes of disease ; manifestly, 
the former is a symptom of disease, and the latter is disease 
itself. 

Extrinsic causes, or those having their origin without the 
body, give rise to almost the entire catalogue of individual 
diseases. Of these external causes, are all the deleterious 
influences of atmospheric changes and contaminations, and 
all ingesta, including air, water, food and drugs used as 
therapeutic agents. 

When pathology was in its infancy, causes of disease were 
classed as proximate and remote ; the former class indicated 
a change of the texture of a part, or lesion of structure — 
which is disease rather than cause; the latter was less objec- 
tionable, as it comprehended all agents and influences 
capable of deranging the system — these are truly causes of 
disease. This class of remote causes was afterwards divided 
into the sub-classes, predisposing and exciting. 

A predisposing cause implies a peculiar state of the 
system, or of some of its parts, which renders it so highly 
susceptive that slight morbific influences act upon it in a 
manner to make deep impressions. This state of the system 
is disease ; so that what have been called predisposing and 
proximate causes are diseases themselves; therefore, both 
are elements rather than causes of disease. The term "pre- 
disposing," or predisposition, applies best in a general sense 
to the maladies of the body, which in consequence of its 
mortality is predisposed to death, and of necessity to disease. 
But a special predisposing cause of disease can only exist in 
so far as one disease causes another, or rather, as an element 
of disease in the body facilitates its own development and 
progress by enfeebling the system and diminishing the 
energies of life and resistance ; while, on the other hand, the 
morbific element is intensified by the ceaseless action of 
numerous causes, both external and internal. 



46 GENERAL PATHOLOGY. 

To illustrate, suppose a child is born of strumous parents ; 
in the course of time it has developed the ivory teeth, the 
squamous nails, the flaxen hair, and the tumid glands — all 
pathognomonic of struma — all evincing that the primordial 
cell had been "touched corruptibly." It would be said, in 
professional parlance, that the individual is disposed to stru- 
mous disease: would it not be more in conformity with 
exactitude to say, the individual is the subject of, or is labor- 
ing under, strumous disease? Such person is surely predis- 
posed to further ravages of the disease, but not to a disease 
already present ; indeed, in this example, the primordial cell 
which developed such individual was strumous. This view 
is in harmony with the deductions derived from extensive 
observation, with the laws of reproduction, and with the 
principles of cell development, as presented in the first 
chapter of this work. 

Again, when a part is congested, the minute vessels are 
mechanically distended by the onus of blood ; therefore, any 
organ that has suffered inflammation is left with its capilla- 
ries expanded. This altered state of the texture will, of 
course, be liable to receive more than a due supply of blood ; 
hence, it is said that a part that has been inflamed is predis- 
posed to a recurrence of inflammation. 

The infirmities of old age indicate change of the textures 
of the body consequent upon the wear of time and use; and 
these lesions, too, have been erroneously classed as predis- 
posing causes of disease. It may be said with some degree 
of propriety, that infants are predisposed to cerebral and 
cutaneous affections. At this early age the brain is in a state 
of rapid development, and is consequently receiving more 
than its ordinary supply of arterial blood. This increased 
amount of blood to, and rapid development of, the brain also 
explains the fact that opium or other hypnotics, when ad- 
ministered to children, readily produce fatal narcotism. 

From the foregoing considerations, it is manifest that the 
terms predisposing and proximate, as applied to causes of 



THE CAUSES OF DISEASE. 47 

disease, have been used synonymously in almost every in- 
stance to imply lesion of structure in some constituent part 
of the body, which is disease itself. As neither of those terms 
has reference to a class of causes of disease, but each of them 
is calculated to mislead by representing disease as cause, 
both may with equal propriety be discarded. 

Exciting and determining causes are equivalent terms, and 
are used to imply any or all influences capable of producing 
disease. To this classification of causes we have no particu- 
lar objections, though the main effect of these terms used to 
qualify cause is unnecessary verbiage. In order to preserve 
accuracy, and at the same time accommodate those who in- 
sist upon retaining these beautiful adjectives, I would sug- 
gest, when disease is already present — when some morbific 
element in the system is excited into intensity — that the 
aggravating influence be called an exciting cause, and that 
determining cause be applied to morbific influences and agen- 
cies when they act with sufficient force to produce disease in 
a system that is in all of its parts natural and healthy. 

Classifications of causes are not so essential as correct 
ideas of the causes themselves, as the essential character and 
modus operandi of each individual cause. These causes are 
of divers kinds; they act in various ways, and produce a 
great diversity of results. We believe it is too clear to ad- 
mit of doubt, that all causes, of whatever kind or nature, 
mechanical causes excepted, produce lesion of the structure 
and derangement of the functions of the system by change 
in the quantity or the quality of the blood ; or, the blood 
may suffer alterations both in quantity and quality, by the 
same morbific agency, as illustrated in the operation of the 
zymotic poisons, and by exposure to cold, damp and inclem- 
ent weather. 

Many of the causes of disease act in a manner so well un- 
derstood, that we are able to determine or point out their 
effects a priori. We shall proceed to enumerate such causes 
in detail, and to present some brief considerations upon the 



48 GENERAL PATHOLOGY. 

several modes in which they produce alterations of the blood 
and consequent lesions of the textures of the body. 

Excess of Food. — This is a prolific source of disease. 
Full living, in persons of sedentary habits, and in whom the 
digestive, assimilative and nutritive forces are carried on 
with energy, produces plethora, and this in its turn gives 
rise to hemorrhage, and to that most destructive element of 
disease — inflammation. 

When more nutriment is taken than can be appropriated 
to the growth or repair of the system, or more than can be 
assimilated, the excess remains as foreign materials, to be 
excreted by the emunctories ; and while retained they often 
undergo such changes as to become, per se, dire elements of 
disease. Thus, when the protean constituents of the food 
are in overabundance, a portion is retained in the blood and 
is converted into urea, which, when in small excess, acts as 
a slow poison by contaminating the blood in a manner that 
leads to chronic inflammation and effusions. But when the 
amount of urea in the blood is in large proportion, its toxic 
action is more intense and decided — producing the most 
profound coma and the most alarming convulsions. In this 
way doubtless originate puerperal convulsions, or the eclamp- 
sia of pregnant and parturient women. The last mentioned 
effects have been ascribed to carbonate of ammonia, into 
which the urea has been converted in its retrograde march 
to a lower form of protein principle. 

That the waste material of certain tissues passes into urea, 
and thence into ammonia, is pretty certain ; and it is a cor- 
roborative fact,- that all practitioners have met the strong 
ammoniacal odor in the apartment of the emaciated typhoid 
patient, and as certainly at the couch of the convulsed 
accouchee. 

Excessive indulgence in delicious wines, and highly 
azotized food, produces an excess of azotized material in the 
blood. This material is in the form of lithic acid, and is the 
materies morbi of gout; and by combining with soda, or 



THE CAUSES OF DISEASE. 49 

ammonia, as a base, forms renal and cystic calculi ; hence 
the near relation between gout and gravel. Those who 
partake largely of food rich in hydro-carbons, and breathe a 
heated and rarefied atmosphere, get an insufficient amount 
of oxygen to consume the combustible material taken in the 
food, so that more work devolves upon the liver than it is 
able to perform ; the result is, this organ is overworked and 
becomes torpid, the hydro-carbons contaminate the blood, 
and bilious attacks and a train of paroxysmal and periodic 
diseases follows. Large quantities of food taken at once 
enfeeble the stomach, exhaust the supply of gastric juice, and 
lead to gastritis and torpor of the digestive apparatus, and to 
consequent indigestion with oligsemia and its train of evils 
such as debility, nerve pains, and hypochondriasis. 

Insufficiency of Food. — The effects of withholding the 
requisite amount of nourishment to supply the demands of 
the system is easily foreseen. Just in proportion as this 
pabulum is diminished will the blood suffer diminution of 
its plastic elements, and assimilation and nutrition will be 
suspended in corresponding ratio. Hence, we have produced 
anemia or oligaemia, with emaciation; indisposition to 
mental effort ; a sluggish performance of all the functions, 
and prostration of the physical powers. This state of the 
system is not a mere predisposition to disease, as it has been 
termed, but it is disease itself. To be sure, any disease 
exposes the system not only to its own ravages, but to the 
ingress of all surrounding morbific influences : and so the 
ill-fed anemic has little capability of resisting the encroach- 
ments of the noxious miasm, or the deadly effluvia that 
lingers in each successive breath, but is a ready prey to 
every morbific influence, whether it is sporadic, epidemic, 
endemic, or contagious. 

Excessive Evacuations are exhaustive to the blood, and 
particularly destructive to its corpuscles. A profuse discharge 
from an ulcer or an issue, excessive sweating, leucorrhea 
and chronic diarrhoea, are alike colliquative, are attended 



50 GENERAL PATHOLOGY. 

with rapid loss of flesh and blood, and tend directly to pro- 
duce anemia and its concomitant results. Each condition 
or state of the system that gives rise to these evacuations is 
disease : here, then, are familiar examples of disease acting 
as causes, but it is clear that they are not predisposing causes. 

Mercury and antimony, when their use is persisted in, or 
when used without great caution, destroy the red corpuscles 
and the crassamentum of the blood, and produce anemia and 
debility, and sometimes lasting cachexia. Hemorrhage 
produces the most sudden anemia and debility. The breath- 
ing of air poor in oxygen produces venosity of the blood, 
and indigestion with its results. Mental depression enfee- 
bles the mind, interrupts digestion, deteriorates the blood, 
and retards assimilation and nutrition. 

Connected with mental emotions are many prolific sources 
of disease. Young females devoted to the reading of novels, 
or who accustom themselves to the no less impure associations 
of theaters and dancing parties, are apt to live into the indul- 
gence of voluptous imaginings which excite the womb and 
ovaries into an irritable and often into an incurable condition 
— shatter the nervous system — blast the hopeful bloom, and 
entail lasting misery. 

Great and sudden emotions of anxiety increase the secre- 
tions in an unequivocal manner ; hence, a nursing woman's 
anxiety about her child, when absent from it, increases the 
flow of milk. It is proper to remark here, that if the nursing 
mother is laboring under the influence of extreme anger or 
grief, her milk will produce disease in the child ; so that 
ill-tempered women are apt to have colicky children. 
Besides, long continued grief tends to produce dementia; and 
a mind encumbered with some depressing thought, often 
becomes so habituated to its unpleasant operations that it 
evades other subjects, and clings to the pang of despair, and 
monomania is the result. 

Exposure to Cold. — The first impression of cold is invig- 
orating to the superficial capillaries and to the muscular 



THE CAUSES OF DISEASE. 51 

fibres ; but this effect is but transient, and is followed by 
permanent debility. Cold applied to the body causes con- 
traction of all the vessels near the surface, which diminishes 
their calibres and drives the blood into the internal organs. 
A person long exposed to cold is apt to suffer inflammation 
of some of the viscera, and this is rendered more probable 
by the circumstances that the air is condensed and rich 
in oxygen, and the blood therefore highly oxygenized. 
Besides, the capillaries throughout the system become enfee- 
bled — those near the surface, by being forced to contract ; 
and those that are deep-seated, by being distended by the 
onus of blood during long continued or often repeated con- 
gestion. In addition, the excretion of waste material is 
scarcely in proportion to the increased amount of ingesta 
taken during cold seasons : so that the system is exposed to 
inflammation and to the most grave forms of continued fever. 

Heat relaxes and debilitates the system by the continual 
and rapid excretion and renewal of the serous portion of the 
blood. Oxydation goes on tardily, and the blood contains 
an unusual amount of excrementitious material, much of 
which finds exit through the pores of the skin. This con- 
dition gives rise to bilious derangements, and facilitates the 
ravages of the animal poisons. 

Alcoholic Liquors, in small quantities and skillfully 
directed, promote the appetite and digestion, and diminish the 
waste of the tissues ; but used habitually and unguardedly 
they are irritant poisons, and in large quantities they are 
narcotic poisons. By long continued and excessive use they 
irritate the stomach and diminish both appetite and digestion ; 
they irritate the brain and nerve centres through the blood, 
and produce wakefulness and mania a potu ; they irritate the 
glands engaged in eliminating them from the blood ; hence, 
drunkards frequently have renal, and more frequently 
hepatic disease, because they furnish more hydro-carbon to 
the blood than the liver is able to excrete ; besides, the 
structure of this organ often suffers lesion by the alcoholic 



52 GENERAL PATHOLOGY. 

irritant. Thus the capsules of Glisson becomes thickened, 
which obstructs the flow of blood through the hepatic vessels, 
and leads to congestion and ascites. 

Local Irritants cause disease readily by augmenting the 
quantity of blood in the part to which they are applied. The 
familiar language, ubi irritatio ibi affluxus, well expresses 
the constant and immediate effect of irritants. To this class 
belong all agencies capable of exciting a part and bringing 
an increased flow of blood to it, whether they are said to act 
mechanically, chemically, or vitally. It is well to remark, 
that the blood which a local irritant invites to a part is 
mainly arterial ; therefore, the congestion it produces is of 
the active variety. 

Marsh Malaria. — The great prevalence of paroxysmal 
fevers and other affections characterized by periodicity and 
hepatic derangements, in marshy districts, is familiar to 
physicians, particularly at the West. The exact cause of 
these diseases has been the subject of much investigation, 
and has led to a great contrariety of opinions, and is yet 
incognito. 

Prof M. L. Linton finds sufficient cause for their produc- 
tion in generous living, on food rich in hydro-carbons, while 
breathing an atmosphere heated, rarefied, and consequently 
poor in oxygen. This appears to be logical, and doubtless 
defines an efficient cause. It is true that those diseases do 
occur on high lands, and are there obviously engendered by 
the causes which Dr. Linton has shown. But may they not 
find in those marshes a potential auxiliary ? If not, why do 
these peculiar forms of disease occur in the marshes so much 
more frequently ? There is no proof that a peculiar miasm 
or virus exists in those swamps; but there are obviously 
miasmata produced there by the damp air, stagnant water, 
and the decomposition of vegetable substances. It is a cor- 
roborative fact that ague, bilious fever, and dysentery, pre- 
vail on the western prairies most in the vicinity of wild lands 
that have recently been ploughed, and upon which heavy 



THE CAUSES OF DISEASE. 53 

coats of grass are decaying. And further, those diseases are 
of comparatively rare occurence in neighborhoods where all 
the adjacent lands have been cultivated. 

Whatever is the cause of these diseases, it acts upon the 
system through the blood, which becomes highly charged 
with hydro-carbons and waste materials which do not find a 
ready exit through the emunctories. Besides, the soft tissues 
are expanded and flaccid, inviting a flow of blood, and giving 
to all these forms of disease a congestive tendency; hence 
arises that state of extreme prostration, cold surface, and 
congestion of most or all of the internal organs, which is 
denominated congestive chill. 

The coup de soldi, or sun-stroke, is evidently a sudden 
rush of carbonaceous blood to the brain. 

Temperaments. — These are generally results of hereditary 
transmission; at any rate, they are conformations or peculiar 
deviations from a normal state of the system, and cannot 
therefore be regarded as prime causes of disease. A well 
marked temperament complicates or modifies disease so far 
that it demands the special consideration of the physician, 
both in diagnosis and in treatment. 

Endemic Poisons. — Certain localities appear to be nurser- 
ies of peculiar causes of disease. Though these morbific 
agencies are noncognizable, their presence is inferred from 
the circumstance that certain peculiar forms of disease are 
common to those localities; these affections are called endemic, 
which name implies that they have been considered as 
existing in the people of a certainty vicinity. To this class 
of causes have been assigned ague, and all other affections 
common to the inhabitants of marshes and jungles. The 
inhabitants of deep valleys are subject to an endemic affec- 
tion known as bronchocele or goitre, which is characterized 
by enlargement of the thyroid gland. It has been supposed 
that drinking snow-water is the cause of this affection ; but 
obviously the triple cause is exclusion from light, breathing 
a humid atmosphere, and hereditary transmission. This 



54 GENERAL PATHOLOGY. 

affection is not uncommon in this country, and is invariably 
a manifestation of scrofula. 

Among the noncognizable causes of disease should be 
included an unknown virus which is common to certain 
localities in some of the Western States; nothing is yet 
known of the mode of its origin or the form in which it 
exists, but its modus operandi as a poison is better under- 
stood. Its immediate effects upon the system are constipa- 
tion, irritable stomach, depraved nerve force, and lassitude 
of the voluntary muscles. It is nocuous to all of the domestic 
animals, and people get infected by eating the flesh or milk 
of animals that are infected with it ; hence the disease it 
produces is called milk sickness. 

Epidemic Poisons. — Closely allied to the endemic, but 
verging on to the well denned contagions, is another class 
of peculiar causes which engender a family of diseases 
denominated epidemic, because they are not confined to any 
particular localities, but come upon the people at irregular 
intervals like the blighting sirocco of Malta. 

These forms of disease appear to depend upon transient 
conditions of, or changes in, the atmosphere; that is, upon 
the presence in the air of some unknown but efficient cause 
which produces in many people, coincidently, la grippe, 
catarrh or pneumonia, or gives a hemorrhagic tendency or 
a low type to all diseases, for an indefinite period, till it is 
exhausted, or rushes on to extend its unwelcome visit and 
scourge other communities with the pang of suffering and 
the gloom of death. Epidemic influences often give intensity 
to sporadic diseases, and to contagions as well. On the 
other hand, some forms of disease which are presumed to be 
the result of epidemic causes only are positively contagious. 
As examples, cholera and typhoid fever are here presented ; 
and even dysentery sometimes presents a malignant grade, 
which renders it capable of propagating itself through the 
noxious exhalations and emanations from the stools or 
body when on the verge of putrefaction. 



THE CAUSES OF DISEASE. 55 

Infectious Poisons —Contagion. — No real difference of 
meaning is understood to exist between the terms "infection" 
and "contagion." Any form of disease capable of propa- 
gating itself, or of being communicated in any manner from 
one person to another, is contagious ; that is, it is "catching." 
The communicability of most of the contagions depends 
upon essential conditions; thus, to infect with the virus 
of hydrophobia, or cow-pox, they must be introduced into 
the system through a wound or abrasion. Others may be 
communicated either by inoculation, by contact, or through 
the atmosphere, as small pox. Syphilis may be communi- 
cated by inoculation with pus from a chancre, and also by 
contact, or it may be imparted through the saliva by a volup- 
tuous kiss. Gangrene may be communicated by inoculation, 
or by inhaling air saturated with the virus. 

Measles, scarlatina, diptheria and typhoid fever, are com- 
municated through the atmosphere; and to this list belongs 
cholera, which, though it is perhaps a more feeble contagion 
than scarlatina, and, although it may exhibit its greatest 
activity in the presence of certain independent aerial re- 
lations, yet it as absolutely, though not so actively, con- 
tagious as small pox. I do not base this declaration alone 
upon either theory or observation, but both alike proclaim 
the incontestable truth. The emanations from the body of 
a person laboring under cholera saturate the surrounding 
atmosphere with the effluvia or virus, which is capable of 
communicating the disease to those who chance to inhale it. 
Cholera is propagated in the same manner as measles, but 
is not so certainly communicated under the same degree of 
exposure. So measles and small-pox may be communicated 
in the same way, yet no one will say that the former is as 
actively contagious as the latter ; but the former does not 
cease on this account to be a contagion, neither does cholera. 

But it is said, cholera is in the air — that we have such a 
thing as a cholera atmosphere. It is granted that certain 
states of the atmosphere promote the activity of all the con- 



56 GENERAL PATHOLOGY. 

tagions ; but when a pestilential disease, such as small-pox 
or cholera, is rife in a community, and scores, perhaps 
hundreds, of infected bodies are emitting from each con- 
taminated and decaying organism abundance of noxious 
effluvia, and filling the air with the seeds of pestilence and 
death, surely we have a small-pox or a cholera atmosphere, 
if we had not before. It is no proof of the negative to say 
that people sometimes expose themselves to cholera with 
impunity ; the same may be said of small-pox, which is the 
most active of all contagions. On the other hand, the fact 
is established beyond reasonable doubt or controversy, that 
many who expose themselves to cholera have been con- 
taminated with the infection. There are numerous instances 
of an individual having been exposed to cholera, and travel- 
ing, during the incubative stage, for many miles, carrying 
the latent virus, that soon manifests itself and spreads till it 
infects most of the inhabitants of a town, and brings pesti- 
lence upon an entire community. 

As to the infective or contagious character of cholera, the 
day of doubt has passed. Its repeated unhappy visitations 
present affirmative evidence more positive than the type 
or quill can present, and far more forcible than pride or 
prejudice can withstand. 

At one period in medical history much discussion occurred 
as to the essential character of the infectious poisons. Two 
theories (the Zymotic and the Parasitic) were presented, and 
each found able supporters ; but the zymotic theory of 
infection for a time prevailed. It is now pretty clearly estab- 
lished that these diseases depend upon a morbid poison de- 
rived from infected animal bodies : that a minute portion of 
this virus entering the blood in any manner, whether from 
the air through the lungs, or by inoculation, is capable of 
contaminating the whole system by a process of fermentation 
or with bacteria- in some instances. The parasitic theory 
is based upon the hypothesis that infection depends upon, 
and is communicated by, living parasites floating in the air. 



THE CAUSES OF DISEASE. 57 

This theory is, perhaps, not more strange than absurd ; yet 
it is known that itch depends upon a parasitic animalcule, 
and that favus is caused by a vegetable parasite ; also diph- 
theria. 

Before leaving the domain of Etiology, it is well to present 
the following deductions derived from the principles ad- 
vanced, viz. : Causes of disease comprehend all agencies and 
influences capable of producing notable change in either the 
quantity or quality of the blood. All causes do act in this 
manner, and in no other way. All changes in the solids 
(mechanical injuries excepted) are preceded and produced 
by adequate changes in the blood. It is obvious, too, that 
each agency and influence classed as a cause of disease, as 
well as each substance taken into the stomach, whether it is 
a drug used as a medicinal agent, or as food for alimenta- 
tion, produces some change in the amount, constituents, or 
quality of the blood; and that, therefore, either of these 
agencies or influences may be so used as to produce or to 
counteract disease. 

It is an important fact that the ocean of atmosphere in 
which we live, and from which we breathe, is the common 
receptacle of all the effluvia that emanates from infected 
human bodies, as well as of the great abundance of miasmata 
emitted from decaying organic bodies and numerous other 
sources. Since the atmosphere is so easily contaminated 
with effluvia, it follows that infection or contagion has a 
wider range of activity than has heretofore been ascribed to 
it or admitted. 

Neither health nor disease is a condition prescribed and 
maintained by the inevitable decree of fate. Either of these 
states of the system may be produced as the result of efficient 
cause, but neither of them can exist except as the result of 
such cause; so that as Etiology comprehends all agencies 
which under certain circumstances are causes of disease, 
Therapeutics comprehends all agencies which under certain 
circumstances are causes of health. 



58 GENERAL PATHOLOGY. 



CHAPTER V. 

ELEMENTS OF DISEASE. 

The preceding deductions drawn from the domain of 
etiology evince clearly, we think, that all causes of disease 
proper affect the system through the blood, and in no other 
way; and since disease invades the system through this 
medium, it is fair to conclude that the essential protopathic 
elements of disease consist in changes in the blood, either 
quantitative or qualitative, or both. The blood may be 
changed both in quantity and quality almost coincidently, 
as by the action of the irritant poisons. It is clear, too, that 
a change in quality of the blood can not proceed far without 
becoming complicated with quantitative change, and vice 
versa; and since by a rapid metamorphosis the blood is 
continually being transformed into tissues, it is obvious that 
the solids suffer corresponding lesions consequent on the 
previous changes in the blood. These changes in, or lesions 
of, the solids also constitute elements of disease; but evi- 
dently these are not primary or protopathic, but secondary 
or deuteropathic elements, which themselves may give rise 
to tertiary elements or affections, and so the elements of 
disease may be multiplied by these numerous sources of 
origin almost to infinitude. 

The blood carries in its torrent the progressive and the 
retrograde elements of the tissues ; it contains a mixture of 
the histogenetic and histolytic materials of the body. Its 
plastic elements are constantly being transformed into tex- 
tures, and, on the other hand, the textures are constantly 
adding their waste materials to the volume of the circulat- 
ing current. 



ELEMENTS OF DISEASE. 59 

Besides, the blood is the receptaculum of all the effluvia 
that pollutes the air we breathe, and of all the deleterious 
substances that are taken into the stomach, either as aliment 
or as medicinal agents. It is in the circulating blood that 
these heterogeneous substances and elements mingle together, 
and consequently it is in this delicate organic fluid we must 
look for the protopathic elements of disease. 

But it may be said this is humoralism. Well, suppose it is. 
It is also evidently the palladium of rational and scientific 
medicine, and is the base upon which our art, guided by 
the beacon light of science, will eventually rest in security. 
Has any physician the credulity to believe that cause can 
exist without effect — that the solids can exist without the 
fluids — or that change in the blood can exist without pro- 
ducing corresponding change in the structures and functions 
of the textures ? The blood of one hour forms a part of the 
tissues of the next, so that the tissues are virtually but the 
blood at rest. 

Since the time of Harvey much importance has been 
attached to the alterations of the blood as connected with 
certain forms of disease. In early times it was supposed 
that there are but few affections in which the morbid im- 
press is first made upon the blood, and even yet we some- 
times hear of a blood disease as if it were a prodigy. But as 
physiology and pathology have advanced, and particularly 
as that important branch of the latter — etiology — has been 
cultivated till it has become an efficient auxiliary in deter- 
mining the modus operandi of causes and the essential 
character of disease, it has become evident that the prime 
elements of all the varied forms of disease consist in alter- 
ations or changes in the quantity and quality of the blood. 
Hence, the black blood of Hippocrates — the alkaline and the 
acid blood of Van Helmont — the error loci of the blood corpus- 
cles of Boerhaave. All these were meager but well-directed 
foreshadowings of an important truth, and in their turn, 
more recently, lead to important investigations into the prop- 



60 



GENERAL PATHOLOGY. 



erties of blood coagula by Gulliver, into the effect of emboli by 
Virchow, to the discovery of leucocythemia by Bennett, and 
turbercle baccilli by Koch. 

Andral conceived a happy thought when he referred all 
disease to the following five classes of lesions : first, lesions 
of the circulation ; second, of nutrition ; third, of secretion ; 
fourth, of the blood ; fifth, of innervation. This classifica- 
tion was evidently defective, but it was an advancement, 
and an approximation to eternal verity. 

But it remained for an American physician — Linton — to 
demonstrate that Andral's lesions of secretion and innerva- 
tion are but symptoms of disease, and to incorporate the three 
remaining classes more comprehensively into qualitative and 
quantitative changes in the blood, and corresponding changes 
in the solids consequent thereon. The classification or for- 
mula of Dr. Linton, of which the following table is a modi- 
fication, will perhaps never be improved or modified further 
than is implied in the suggestion already made — that the 
prime elements of disease consist in quantitative and quali- 
tative changes in the blood, so that the alterations or lesions 
of the solids being consequent thereon are secondary elements. 



PRIME ELEMENTS OP DISEASE. 



Changes in the quan- 
tity of the blood. 



General. 



Local. 



( Plethora or 
< Hypermia. 
I Anemia. 



f Active. 



I Hyperemia, | paggive 
I Anemia. 



Changes in the qual- 
ity of the blood. 



r Consisting in variations of its con- 
stituent elements — as in the fibrin, 
albumen, globules, etc. 

• Consisting in retention of matters 
destined for secretion, etc. 
Consisting in contaminations with 
foreign poisons, as the miasms, 
baccilli, etc. 



Changes in the solids 
consequen 

foregoing. 



ELEMENTS UE DISEASE. 61 

SECONDARY ELEMENTS OF DISEASE. 

Increased nutrition (hypertrophy). 

Decreased nutrition (atrophy). 
IU T° Perverted nutrition produces all 
other changes to which the solids 
are liable, as tumors, both benign 
and malign. 

Manifestly this classification includes every known ele- 
ment of disease. It is plain that the quantity of blood 
may be increased above, or diminished below, the normal 
standard, and that this increase or diminution may be 
general or local. It is clear, too, that a change in the 
quantity of the blood in any of these ways is an element of 
disease. Thus, if the quantity of blood be increased gener- 
ality, it is disease — it is plethora or general hyperemia. If 
the quantity of blood be increased locally, it is local hyper- 
emia or congestion. Surely this, too, is an element of 
disease. If the quantity of blood is diminished generally, 
there is general anemia or oligsemia; and if diminished 
locally, there is local anemia. 

Changes in the quality of the blood, including all known 
bacteria, are also elements of disease. Thus changes in the 
component elements or constituent parts of the blood con- 
stitute various elements of disease, as does the retention of 
materials destined for secretion and elimination ; also, the 
miasms which are received into the blood from the atmos- 
phere through the lungs. 

Disease is prolific ; hence, each element is capable of pro- 
ducing results which become per se, elements of disease. 
So that the forms of disease are varied and numerous, 
though the prime elements are few. Thus, a general in- 
crease of the quantity of food constitutes general plethora, 
and this condition gives rise to local congestion, apoplexy, 
or exhausting hemorrhage. If the increase of blood be in a 
local part, the prime element is congestion, or local hyper- 
emia, which may produce hyper-nutrition and hypertrophy, 



62 GENERAL PATHOLOGY. 

or increased oxydation, and all the results of inflammation 
may follow, and general anemia and its results are among 
these consequences. In this manner one element of disease 
may generate another, till the system undergoes a countless 
succession of changes. If the quantity of blood in the sys- 
tem is diminished below the normal standard general anemia 
is present as an element, giving rise to a train of affections 
connected with the nutritive process. If the blood is dimin- 
ished locally, the local anemia gives rise to diminished nutri- 
tion and atrophy of the part. So much for a cursory view of 
the changes in the quantity of the blood as morbific elements. 

Changes in the quality of blood are almost innumerable, 
and in these consist the elements of various communities of 
disease. The zymotic poisons and all the contagions, whether 
communicable through the air or by inoculation, are ele- 
ments of this class. All morbific ingesta, whether in the 
form of air, water, food, or drugs, are capable of altering the 
quality of the blood, and thus becoming elements of disease. 
Diathesis, and almost all diseases capable of hereditary trans- 
mission, are included in this very large class of affections, 
the prime elements of which consist in qualitative changes 
in the blood. Any element, whether it is protopathic or 
deuteropathic, may give rise to other elements, and they in 
turn may give rise to other affections or complications, 
differing widely in their character from the prime element. 
Thus the quality of the blood may be changed in the follow- 
ing manner : the albumen which in health should be to the 
whole volume of the blood in the proportion of 80 to 1,000 
parts, in disease may be increased to 100 or 120 parts in 
1,000, and may be so diminished in plasticity as to assume 
a low form ; and if deposited in the lungs or elsewhere, will, 
by an abortive organic effort, develop tubercles, which, in 
their crude state, may, by mechanical irritation, generate an 
inflammation. Here, then, is an element quite different 
from the original one. Such examples are numerous, and 
will readily suggest themselves to the reader. 



ELEMENTS OF DISEASE. 63 

We think that a moment's reflection will make it clear to 
every mind accustomed to methodical thought, that all 
lesions of the solids, not produced by the direct action of 
some mechanical or chemical agent, are secondary elements 
of disease, being consequent upon some preexisting element 
that consists in alteration of the quantity or quality of the 
blood. For instance, congestion, which we have seen is itself 
a very important element of disease, may, by the onus of the 
congestive element, rupture a minute vessel and give rise to 
hemorrhage so exhaustive as to induce anemia with its train 
of concomitant evils, or it may be attended with effusion of 
serum into some of the splanchnic cavities, or among the 
tissues constituting the various forms of dropsy, or it may 
be attended with hyper-oxydation and all the results of in- 
flammation, including destruction of the textures involved, 
or it may be attended with hyper-nutrition and hypertrophy 
of the part, and lead to results more or less serious, according 
to the importance of the organs or parts involved. Surely 
in all these examples, and in every instance that can be 
suggested, the alterations or lesions of the solids are results 
of prime elements of disease consisting in previous change 
in the blood, quantitative, qualitative, or both. 

Andral's lesions of nutrition answer to these secondary 
elements of disease or lesions of the solids, but it is very 
evident from what has already been adduced that all possible 
lesions of nutrition are consequent upon previous changes 
in the blood. The blood forms and nourishes the tissues, 
therefore it is obvious that any notable change in this plastic 
fluid, whether qualitative or quantitative, must of necessity 
produce corresponding changes in the structures and func- 
tions of the various organs and parts. The essential con- 
ditions of nutrition are : first, a due supply of nutritive 
aliment ; second, the assimilation to the blood of its plastic 
elements ; third, the appropriation of these elements to the 
various organs and textures of the system, in kind and 
quantity adequate to their several demands. This power of 



64 GENERAL PATHOLOGY. 

distribution and appropriation of the plastic elements of the 
blood to the various organs and tissues has been ascribed to 
some influence inherent in the textures. It is extremely 
doubtful whether, under any circumstances, the organs or 
textures possess this inherent capability, and it is certain 
that the histogenetic process is governed and directed en- 
tirely by the blood ; that the blood must be of such quality 
and quantity as to contain all the required materials in just 
proportion ; that it must contain them in sufficient quantity, 
and not in over-abundance, and that it must be in equili- 
brium. 

The blood may be increased, decreased, or contaminated, 
and the corresponding results are — increase, decrease and 
perversion of nutrition, and of organic activity ; so that it is 
very clear that the textures do not regulate and control the 
nutritive process; but that the blood furnishes the nutritive 
material, forms the organs and textures, and regulates their 
functions. The foregoing considerations present the process 
of nutrition in a comprehensive light, and upon principles 
entirely reasonable and corroborative of all that is known of 
organic life or physical law, into which what have been 
called vital power and organic force are rapidly converging. 

Each kind of tissue receives from the blood such material 
as its own peculiar structure requires, and the influence 
which regulates these supplies and draws the material from 
the torrent of the circulation has been ascribed to attraction, 
and the appropriation to each kind of tissue of the special 
constituent of the blood which its growth or repair demands, 
has been ascribed to selection or choice on the part of the 
textures. 

But it is most consistent with all that is known of the 
operations of the animal economy to conclude that the 
textures are entirely passive to the nutritive process, and 
that certain constituents of the blood are supplied to each of 
them to answer their several demands, in consequence of 
affinity existing between each kind of tissue and certain 



ELEMENTS OF DISEASE. 65 

elements of the blood. This mutual affinity is evidently the 
influence that furnishes to the brain unoxydized phosphorus, 
to the muscles albumen, and to the bones and cartilages 
phosphate of lime. To suppose these tissues capable of 
exercising choice in obtaining their appropriate material 
from the blood, is as absurd as to attribute volition to the 
heart, or supreme munificence to a Pagan god. 

Then it is evident that lesion of nutrition consists in 
change in the blood, either qualitative or quantitative, the 
effect of which upon the tissues is corresponding alteration 
of their structure. Thus, if nutrition is increased in a part, 
the result is hypertrophy ; if diminished, the result is atro- 
phy; if perverted, the result, is atheromatous or heterogene- 
ous tumor, or the deposit of tubercle will be likely to occur 
if the nutritive material is diminished at the same time. 
Could either of the above mentioned changes in the solids 
occur without being preceded by changes in the blood? No. 
Can any change that is not the result of violence occur in 
the solids without being preceded and caused by change in 
the blood ? Surely not. 

The following propositions are now pretty clearly estab- 
lished : that the prime elements of disease consist in changes 
in the blood; that lesion of nutrition must be preceded by 
change in the blood ; that the lesions of structure are second- 
ary elements of disease, and are consequent upon previous 
changes in the blood. 

Before closing these general remarks on the elements of 
disease, it is well to state that when any morbific element is 
in the system, it is disposed to direct its violence upon some 
certain kind of tissue ; that is to say, as in the nutritive pro- 
cess each kind of tissue appears to have affinity for some 
proximate element of the blood, so each appears to possess a 
kind of affinity for certain peculiar morbific elements. Thus 
the venereal poison affects the generative organs ; mumps 
affect the parotid glands ; scrofula affects the glandular, 
and finally the osseous structures ; rheumatism, the fibrous 



66 OENEKAL PATHOLOGY. 

tissues, and the poison of typhus affects the nervous tissues 
and the mucous membranes. 

Not only in the elements of specific diseases is affinity 
manifested, but it declares itself in the materies morbi of 
epidemic and endemic affections as well ; and even in spo- 
radic diseases the same phenomena are presented. Thus, if 
an individual suffers with inflammation of the pleura, it is 
evidence that all the serous membranes are alike disposed ; 
and this is true of each of the various kinds of tissue that 
compose the system. 

It is important in each special disease, if possible, to 
determine the character of the prime element, and to dis- 
criminate closely between the idiopathic disease and the 
consequent affections and complications which it engenders. 
A clear distinction should be observed between disease and 
symptoms — between lesion of the organization and derange- 
ment of function. Functional disease is a misnomer, and a 
cloak for ignorance. 



GENERAL ANEMIA. 67 



CHAPTER VI. 

QUANTITATIVE CHANGES OF THE BLOOD, AND THEIR RESULTS. 

The blood in the healthy adult weighs about thirty pounds ; 
it is the pabulum vitse, and is continually moving in the cir- 
culatory system, which is a perfect hydraulic apparatus. As 
this organic fluid is circulated in a system most delicate and 
complicated, we would conclude a priori that its equilibrium 
would be readily and frequently disturbed ; and so we find 
that it is very liable to quantitive changes, general and 
local, and that such change in one part necessitates corre- 
sponding change in other parts ; thus, congestion of the brain 
induces anemia of the feet. These quantitative changes and 
their results, as we shall see further on, comprehend many 
elements of disease. 

General anemia, or, in literal strictness, oligsemia (which 
signifies little blood), is caused by whatever exhausts the 
blood, or prevents its formation. Of the former class of 
causes are hemorrhage, contaminating influences, and inor- 
dinate secretions ; of the latter class is imperfect assimila- 
tion, whether from deficiency of aliment taken as ingesta, or 
from such digestive or assimilative derangement as prevents 
the nutriment from being appropriated to the blood. Gen- 
eral anemia occurs mainly at the expense of the iron and red 
corpuscles of the blood, and the diminution in volume is 
usually compensated by increased additions of water to its 
serum ; hence the frequent coexistence of anemia and hy- 
dremia. 

The symptoms and signs of general anemia are generally 
well marked and declarative of its presence. The skin is 



68 t GENERAL PATHOLOGY. 

pallid, and whether there is emaciation, or a symmetrical 
and rounded fulness of the soft textures, the evidences of 
anemia are still obvious ; there are softness and flaccidity of 
the muscles, impaired contractility of their fibres, and defi- 
ciency of their power, and therefore a corresponding degree 
of physical debility. When anemia has reached an extreme 
degree, the mind is very impressible by moral influences, 
while the mental faculties are enfeebled and incapable of 
investigating abstruse propositions. Impaired nervous energy 
is usually present as a consequence of deficient nutrition, and 
in this condition there is often exaltation of certain nervous 
centers, which give rise to heightened functions of the 
nerves over which they preside, as frequently evinced by 
neuralgia and hyper-esthesia. These phenomena, as well as 
those pains, erroneously denominated sympathetic, which 
manifest themselves in parts remote from a local irritation 
or inflammation, depend on irregularity in the distribution 
of reparative material, or a want of balance in the nutritive 
process. This state is well exemplified by the excruciating 
pains, excessive tenderness of parts, and the impressible 
mind common to hysterical females : though these may 
come half solicited, they are to the sufferers terrorism, and 
are the effects on the mind and nervous system of anemia, 
particularly when it is associated with uterine derange- 
ment. 

Treatment. — The principles on which the treatment of 
anemia is directed are obvious enough ; the signs and 
symptoms are indicative of the state of the system, and this 
condition in turn plainly indicates appropriate remedial 
measures. Tonics, nutrients, pure air and moderate exercise, 
with such measures as may be necessary to restore or main- 
tain a healthy condition of the digestive organs, are the most 
efficient means in the treatment of anemia, and are decidedly 
and certainly curative. Of course, complications when pres- 
ent are to be treated according to their indications ; if anemia 
is kept up by excessive secretions, exhaustive discharges, or 



LOCAL ANEMIA. 69 

other causes, such additional means as are calculated to 
arrest them, or remove the conditions on which they depend, 
will be necessary. 

Local anemia may be produced at will in any part that 
can be exposed to moderate pressure or extreme cold. Con- 
gestion of the abdominal and thoracic viscera produces 
anemia of the skin ; cerebral congestion causes anemia of the 
extremeties ; or when the motor power of a limb or the func- 
tional activity of any organ is suspended, anemia of the organ 
or part is the result. And further, when the supply of blood 
to a part is diminished, the nutritive material is of course 
correspondingly withheld from the part; so that as anemia 
is the result of pressure or inactivity, so atrophy is the result 
of anemia. Hence, we find atrophy of the muscles of a 
palsied arm or leg, and of glands which have long remained 
dormant. If from any cause one kidney suspends functional 
activity, it receives less blood and deficiency of nourishment, 
and therefore becomes atrophied ; while its fellow peforms 
an increase amount of labor, and receives augmented sup- 
plies of blood and nutritive materials / and therefore becomes 
enlarged or hypertrophied : so that, under these circumstan- 
ces, the relative difference of size between the two kidneys 
in the same body is considerable. Men who abstain from 
connubial rites, and avoid the excitement of coition, are 
liable to atrophy of the testes ; and it is an obvious and 
important truth, that the brain of a person ud accustomed 
to the exercise of the reasoning faculties is not nearly so well 
developed as that of an individual devoted to thought and 
mental culture. 

It is in order to mention, in this connection, an obvious 
fact which many eminent authorities in the profession have 
sought to invalidate, to-wit: that certain faculties of the 
mind do originate in and belong to definite special localities 
of the brain. As these faculties of the mind are exercised, 
their appropriate regions of the brain receive increased sup- 
plies of blood and nutritive materials, by which development 



70 GENERAL PATHOLOGY. 

is accordingly augmented; so that the brain, like other 
organs, perishes by inactivity, and is developed by the 
exercise of its functions. But the brain does not act as a 
unit ; for it is clear that each of its various regions has inde- 
pendent functions, with but a relative dependence on each 
other, and that the various dispositions and grades of intellect 
in people depend on as innumerable differences in the struc- 
ture and development of the various regions of the brain. 
These differences in development may be natural or culti- 
vated ; so that these truths do not proclaim irrevocable fate, 
but that each individual is a free agent, and capable of suc- 
cessfully cultivating his or her own brain, and improving 
the morals and the intellect. These views are sustained by 
plain physiological facts ; to deny them is as absurd as to 
deny the circulation of the blood — and this was denied by 
leading men in the profession for more than a century after 
it was discovered by Harvey. 

The objection that the bony covering of the brain prevents 
its development, is too frivolous to notice here. It is dis- 
proved by physiology and by the reason and experience of 
everybody ; besides, it defines the veritable teachings of phi- 
losophy and physiology ; while, on the other hand, we are 
sustained by the following facts, to-wit : No particle of matter 
is exempt from the philosophical law of cause and effect ; the 
brain is not exempt from the physiological law that active 
exercise of the functions of any organ, or part, increases the 
amount of blood distributed to it to augment its develop- 
ment. Hence, in profound study we exercise the brain, and 
especially a certain region of it, by which its supply of blood 
is increased, its development augmented, and its faculties 
expanded. Disprove these evident propositions, and thought 
is useless, physiology is a delusion, and philosophy but a 
chimera ; we could neither progress in the science nor grow 
in morals. 

It remains yet to notice some facts in support of the locali- 
zation of particular faculties of the mind in special regions 



ATROPHY. 71 

of the brain. This proposition is established by many con- 
clusive evidences that the brain does not act as a unit. The 
faculties of the mind are not developed contemporaneously, 
but at different periods of life, and in the same independent 
manner do these faculties decline ; thus conforming to the 
general mechanism of the system, in which each organ is 
assigned special functions and periods of activity. 

That each of the powers of the mind is as independent of, 
as distinct from the others, is well exemplified in disease. 
In typhoid fever, the sufferer readily recognizes acquain- 
tances when every other faculty of the mind is perverted or 
abolished. Some insane persons have more sense on some 
subjects than they ever had before. Monomaniacs are 
perfectly rational in some of their faculties, while the other 
faculties are entirely abolished. Indeed the whole nervous 
system is constructed on this principle of special localization 
and definite independent functions, as shown by the separate 
localities and definite functions of the ganglia and nerves of 
sensation, motion and vision. This arrangement of the 
nervous system and the comparative anatomy of the entire 
organism have been presented in support of the special 
localization -of the functions of the brain by Prof. J. W. 
Draper of New York. 

The author does not propose to endorse all the minutia that 
may be taught as phrenology ; but that the leading propo- 
sitions of that science are as true as the cardinal principles 
of physiology or physics, is believed to be placed beyond 
cavil by many incontrovertible facts, only a few of which 
are here adduced. 

But to proceed : we were considering atrophy as a result 
of local anemia, but this element of disease has a range of 
consequences far beyond simple atrophy, which consists in 
diminution of the bulk or structure of an organ, or part, 
without any change in the normal character of the tissue. 
But there may be both diminution and alteration of the 
structure of an organ. Simple diminution of structure is 



(Z GENERAL PATHOLOGY. 

but a stage in the decay of an organ deprived of blood and 
nutrition, beyond which morbid degeneration of the remain- 
ing texture may occur. These morbid degenerations of 
texture are, according to Dr. Bennett, of four varieties, viz.: 
Albuminous, Fatty, Pigmentary and Mineral. 

Albuminous Degeneration. — Albumen is a highly nutritious 
substance, and is truly protean in the great variety of changes 
to which it is liable. It readily becomes the fibrin of muscles, 
the gelatin of bones and cartilages, and it contributes azotized 
material to the formation of the walls of the blood-cells ; and, 
on the other hand, the tissues of muscles, glands, and other 
textures, are capable of degenerating into an albuminous 
substance, as the consequence of suspended or perverted 
nutrition. 

The writer has more than once observed in post mortem 
examinations of the subjects of pulmonary tuberculosis, that 
the liver was small and oily, and presented to the eye a pale 
or whitish color. Manifestly such structural changes are 
the results of imperfect nutrition. These lesions are not 
easily diagnosed, and therefore do not often receive special 
treatment. It is, however, advisable, on any reasonable 
evidence of the presence of such lesion, to resort to such 
measures as give activity to the nutritive process. 

Fatty Degeneration. — This is a lesion which most of the 
textures of the body are liable to suffer. It may affect the 
muscles, both voluntary and involuntary, but is less frequent 
in the latter, though the heart is not unfrequently attacked, 
especially in persons of a lymphatic temperament, and in 
whom the contractions of this organ have been enfeebled by 
previous disease. This morbid degeneration may be found 
in the osseous, glandular and nervous tissues, giving rise in 
the former textures to a form of mollifies, and in the latter 
to romollesence ; but this degeneration is not the only 
pathological process that leads to softening of the bones nor 
of the brain and spinal cord. The placenta, false mem- 
branes, and morbid growths, are all liable to this lesion. 



DEGENERATION OF TEXTURES. 73 

The causes of fatty degeneration are pretty obvious. Im- 
perfect nutrition is an essential cause common to all the 
groups and varieties of degeneration of texture, and with 
this, various incidental circumstances and transient influ- 
ences combine to give rise to the different varieties. Fatty 
degeneration is caused by anemia, and such other conditions 
as deprive an organ, or part, of its usual supply of nutritive 
material, while the fats and other hydro-carbons are actively 
assimilated and appropriated to it in due or over-abundance, 
so that the suffering organ is fed by and converted into fat. 
There is, then, this essential difference between fatty degen- 
eration of texture and fatty deposits or growths. In the 
former the fat is formed at the expense of the texture, in 
the latter the fat is merely deposited on healthy textures. 
But a lipoma may produce pressure on adjacent tissue, and 
thus produce in the part anemia, atrophy, and finally fatty 
degeneration. 

The diagnosis of fatty degeneration of internal parts is not 
aided by any known positive signs or reliable symptoms, 
and cannot, therefore, in the present state of science, be 
positively determined upon in the living subject. The 
treatment, when its presence is sufficiently probable, should 
be directed on general principles. All hydro-carbons should 
be withheld, and a proper balance of the nutritive forces 
should, if possible, be restored. 

Pigmentary Degeneration. — Pigment is a carbonaceous 
substance closely allied to fat. It is a normal constituent 
of the rete nucosum, or lowest layer of the cuticle. It is 
more abundant in the dark than in the fair races, and it 
may present any shade of color owing in a measure to solar 
influences, but more especially to hereditary transmission ; 
hence the various colors of the races. In the negro, the pig- 
ment is black, and is therefore denominated "pigmentwn 
nigrum" The quantity of pigment may become much re- 
duced, or that which was dark may change to a light color, 
under some morbid influence connected with the processes 
6 



74 GENERAL PATHOLOGY. 

of nutrition and absorption, and this explains the wonderful 
and rare phenomenon of a negro turning white. 

The pigment is liable to degeneration and various changes 
in quantity, as results of causes similar to those which pro- 
duce like changes in fat, to which it is closely allied in its 
chemical constitution. But its most obvious changes are 
those to which the fats present no similarity, to-wit: the 
various shades of color, as black, brown and yellow, which 
it is liable to present under certain morbid influences. 
These changes appear to be chemical, and to be produced 
by alterations in the hematin of the blood. As remedial 
measures, the deductions derived from the foregoing con- 
siderations suggest the avoidance of carbonaceous ingesta, 
and enjoin nourishing food, moderate exercise, frequent 
ablutions of the skin with cold or tepid water, tonic medi- 
cines, and a temperate climate. 

Mineral Degeneration implies the deposition of mineral 
substances in any of the soft textures. It differs from the 
concretions in this, that the intruding material is not de- 
posited in an accumulative mass, but is diffused through the 
tissues, imparting to them hardness and brittleness ; so that 
when this lesion affects the heart or large arteries, it exposes 
them to the danger of fatal rupture. Every texture in the 
system is liable to this abnormity, and is most likely to 
occur in connection with fatty degeneration. 

Plethora, or General Hyperemia. — Increase of the amount 
of blood generally, and of the red corpuscles specially, above 
the normal standard, constitutes this element of disease. It 
is not of frequent occurence nor of much importance, except 
in rare instances, when it gives rise to internal hemorrhage ; 
or when the texture of an organ or part is excited by a local 
irritant, either mechanical or chemical, or by the over- 
abundance of oxygen carried by the red corpuscles, the blood 
forms a nidus in the irritated texture, and thus we may have 
active congestion — a formidable element of disease, to the 
consideration of which the succeeding chapter will be devoted. 



LOCAL HYPEREMIA. 75 

The causes of general hyperemia are free indulgence in 
nutritious food ; breathing a pure air ; diminished secretions, 
and sedentary habits, conjoined with active digestion and 
assimilation. Plethora in the young, active and robust, 
is called active ; when it has existed long, and the muscles 
have become sluggish, and the superficial vessels are seen 
dilated and tortuous under the long continued incumbrance 
of their unnatural onus of blood, it is called passive. This 
is a distinction with a difference that would be as well 
expressed by the terms acute and chronic, as they are applied 
to most affections according to the order of time. 

Plethora is well indicated by symptoms and signs. The 
lips and cheeks are red, the pulse full, and the arteries 
bounding ; the bowels are generally constipated ; the secre- 
tions are diminished or repressed, and sleep is enjoyed much 
better than muscular exertion. These latter symptoms are 
most prominent in the passive variety, or chronic stage. 

The treatment of general hyperemia is plainly indicated 
by the state of the system. Muscular exercise and limited 
indulgence in alluring viands should be enjoined, and, in 
addition to these essential measures, occasional cathartics 
and such other mild depletory measures as are calculated to 
obviate fullness of habit. 

Local Hyperemia, — This is an element of most frequent 
occurrence, and often of momentus importance. It implies 
a local congestion, or increased amount of blood in some 
organ or texture. It is divided into two kinds, or varieties, 
by a well-marked difference which it is important to distin- 
guish. When the blood that accumulates in a part is arte- 
rial, the congestion is active ; when the accumulated blood 
is venous, the congestion is passive. Both of these varieties 
of congestion will be considered in ample scope further on 
when we shall have briefly noticed some of the consequences 
of local excesses of blood and nutrition. In direct antagon- 
ism to anemia, atrophy, and the various morbid degenera- 
tions of texture, do we often find hyperemia, hypertrophy, 



76 GENERAL PATHOLOGY. 

and the various morbid growths. Any mechanical irritation 
or other influence capable of causing an accumulation of 
blood in any part may give rise to local hyperemia, and this 
in turn induces hyper-nutrition, and hypertrophy, and this 
latter may be but an augmentation of the normal texture 
of the part, or the newly formed structure may be unlike 
any of the normal textures of the body ; and in view of 
this difference morbid growths have been divided into two 
classes, and denominated respectively homologous and heter- 
ologous. 

It is not to be inferred that every hyperemia ultimates in 
a morbid growth, nor that those growths can originate in no 
other way ; but that a majority of them have their origin in 
a local hyperemia, and that all are developed by nutrition 
from the blood. These propositions, we think, are sustained 
by the most positive teachings of pathology. It is certain, 
too, that diathesis and cachexia influence the origin and 
character of morbid growths, and these constitutional causes 
usually fix the location of the growth. Thus, where there 
is a rheumatic diathesis, osseous growths appear as if by 
preference at the extremities of long bones; but if the 
cachexia is syphilitic, nodes and oxostoses appear as 
constantly at the continuity of the bone, and, under the 
influence of the same constitutional taint, epithelioma is 
generated and its site fixed on or about the genitals. Morbid 
growths usually partake more or less of the nature of the 
textures in which they grow. 

Some ingenious reasoning has been presented by Prof. 
Bennett, by which he is led to conclude, that, unlike a 
primordial cell, the molecule, or the infiltrated cell from 
which a morbid growth springs, is not impressed with any 
definite type or character by which its future development 
is in any way influenced ; but when considered in view of 
the laws governing development generally, the proposition 
appears rather more than doubtful. It is true that every 
development is modified by attendant circumstances and 



MORBID GROWTHS. 77 

influences in various ways, and it is thus that abnormal 
textures and organisms are developed ; but the process by 
which they are developed is natural, and the abnormity is a 
natural result of all the circumstances and influences under 
which it is formed. But a parent cell directs the results of 
its development as well as interposing influences ; so that, as 
regards morbid growths, benign and malign often express a 
generic difference between them that was as real in the cells 
from which they were developed as it is obvious between a 
wen and a cancer. Almost any benign growth may become 
malign ; but a malignant growth — a carcinoma, for instance 
— becomes benign never. 

Morbid growths, then, are properly divided into the two 
species, Benignant and Malignant; but one of these moves 
insensibly into the other by a series of descending degrees 
inversely to the progressive gradation in the scale of organi- 
zation from the plant to the animal, or from the monkey to 
the man. So tumors present every grade of character, from 
the simplest serous cyst to the most malignant carcinoma. 
Cachemia tends to develop cancer, in the prone ; local lesion 
acts as an exciting cause ; hence, malignant disease of the 
womb is rarely seen except in women having both a cachexia 
and an old laceration or ulceration of the cervix. 

A benign growth, so long as it maintains its generic 
character, can do no harm, except as a parasite, or as a 
nuisance in consequence of its bulk, weight and pressure. 
But not so of the malignant tumor; it is prone to the 
destruction of texture, and its encroachment is often rapid 
and irresistible : besides, it is but a local manifestation of a 
general cacsemia, and if this condition of the blood did not 
preexist, it is rapidly induced by the molecules generated in 
the fluid of the morbid growth during its development, and 
it is therefore generally recurrent. 

Between these two species of tumor, the differential diag- 
nosis is facilitated by observing the characteristics peculiar 
to each of them. The benign tumor is developed slowly and 



78 GENERAL PATHOLOGY. 

without constitutional disturbance ; and if it is superficial, 
it moves readily from its place by the slightest manipulation, 
and the line of demarkation between it and the normal tex- 
tures is well shown. On the other hand, the malign growth 
is likely to be developed rapidly ; to palpation it imparts a 
sensation of doughy firmness ; the skin and subcutaneous 
tissues appear to be firmly attached to its superficies, so that 
it is not readily moved from its place. No obvious line of 
demarkation shows where it ceases and the normal textures 
begin, and there is sooner or later constitutional disturbance, 
of which one of the earliest evidences is manifested by swell- 
ing of the glands in the axilla or groin. 

Remedial Measures. — The treatment of morbid growths 
belongs mainly to the domain of surgery. If the nourish- 
ment of a tumor can be suspended by depriving it of blood, 
it is well ; with this view, pressure, cold, and the ligature, 
have each in turn been applied, and the latter at least often 
with success. But the means usually resorted to for the 
extirpation of morbid growths are chemical agents and the 
knife. An efficient application is formed of chloride of zinc 
one part, wheat flour three parts, with a sufficiency of water 
to form a paste. A surgeon should not hesitate to remove a 
benign tumor at once, either with the knife or other efficient 
means. As regards those which are manifestly malignant, 
the attendant circumstances in each individual case are to 
the wise practitioner the surest counselors. It is but just to 
state here, that in many instances malignant tumors never 
recur after their removal. 

There is one other effect sometimes produced upon the 
textures by excess of blood in a part, or local hyperemia, 
which we wish to notice en passant, to-wit : softening of the 
brain and spinal cord, and breaking up of their cells and 
nerve tubes. We noticed this condition as a result of anemia 
when treating of that element and its consequences, but this 
lesion, mollities cerebri et medullse spinalis, occurs much moer 
frequently as a result of active congestion, and as the conse- 



SOFTENING OF THE BRAIN. 79 

quence of mechanical injury to those textures produced by 
the extravasation of blood. 

It is very difficult to arrive at certitude in the diagnosis 
of this or any other lesion of the brain or spinal cord. The 
symptoms and fatality of lesions of nerve centers vary greatly 
according to the special region involved. Thus, lesion of 
the anterior columns of the spinal cord, involving the grey 
matter and a motor root of nerves, gives rise to paralysis of 
voluntary motion; and a similar lesion of the posterior 
columns destroys sensation. Softening of the medulla 
oblongata never occurs, because this center is so essential to 
respiration, that when it suffers lesion death contravenes all 
successive stages. Softening of the pons varolii produces 
convulsions and paralysis. This, or any other lesion of the 
textures about the center or base of the brain contravenes 
locomotion and the motor powers generally, while a similar 
lesion of either of the cerebral hemispheres disorders the 
mental faculties or dethrones reason. 

Sometimes softenings or other lesions occur coincidently 
in two or more regions of the brain, or of the cerebro-spinal 
axis, thus grouping together many contradictory symptoms 
in such confusion and contrariety as are well calculated to 
baffle the unguarded practitioner out of a correct diagnosis. 

Softening of any portion of the nervous texture gives rise 
to a train of symptoms very like those produced by the 
extravasated blood in the same locality, so that the exercise 
of a fine discrimination is required in making the differential 
diagnosis. The loss of sensation or motion comes on sud- 
denly when it is caused by a clot of blood in the texture of 
the brain or cord. Such attacks are never preceded by pre- 
monitory symptoms except when the hemorrhage depends 
upon the softening and rupture of a vessel. On the other 
hand, when softening is the ipse morbus, the mania or the 
paralytic attack is almost invariably preceded by premoni- 
tory symptoms, such as loss of memory, ringing in the ears, 
diminished sensibility, or defective mobility, till finally 



80 GENERAL PATHOLOGY. 

either spasms, paralysis, dementia, or this whole trio, appear 
and establish their coming. 

Passive Congestion — Results — Remedies. — Venous congestion 
is caused by obstruction to the return of the blood to the 
heart, by which the capillaries emptying themselves into 
the obstructed vein become distended and engorged with 
blood. This blood being in a high carbonaceous state can- 
not generate inflammation, but may as a legitimate result 
induce passive hemorrhage by the effusion of the detained 
blood, or the serous portion may be effused into some of the 
excretory canals — Flux; or the effusion may be into the 
intercellular tissue, or into some of the shut sacks — Dropsy. 
In this way cardiac and renal dropsies have their origin, in 
consequence of obstruction in the valves of the heart in the 
former, and of the emulgent veins in the latter. Obstruction 
in the portal or hepatic veins, or thickening of Glisson's 
capsules, will cause passive congestion of the abdominal 
viscera, and consequent dropsy of the peritoneum — Ascites. 

Pulmonary disease in some of its forms, as emphysema, 
may render the expiratory act distressingly laborious, and 
thus give rise to congestion by opposing the return of blood 
through the veins, also by partially counteracting that suc- 
tion influence which invites the blood into the pulmonary 
capillaries at each inspiration. The veins being more super- 
ficially seated than the arteries, will more readily contract 
under the influence of external cold ; the volume of blood 
which they xeturn to the heart being diminished, congestion 
of the viscera and deep-seated tissues will ensue; one or 
more of the most active emunctories thus suffering con- 
gestion at the same time, with consequent inactivity of 
secretory function, foreign materials are retained in the 
system which are per se elements of disease. 

Tubercular deposits in the lungs favor venous congestion 
in those organs, evincing the protective power of nature in 
supplying the diseased part with carbonaceous blood, which 
is antagonistic to tubercle. 



PASSIVE CONGESTION. 81 

Congestion may arise from atony of the vessels, as in the 
zymotic fevers, and in the sinking which precedes death ; the 
heart in its enfeebled condition is not able to propel the 
blood in due supplies to the extremeties ; but the force of the 
heart is not only enfeebled, but impeded by the relaxed 
parieties of the vessels. The veins and capillaries being 
sparingly supplied with tonic contractile fibres, are more 
susceptible to the congestive influence, also parenchymatous 
structures. Owing to the relaxed parieties of the vessels the 
blood follows the law of gravitation, distending those vessels, 
and congesting those parts most which are lowermost — 
Hypostatic Congestion. It is seen in the posterior regions of 
the bowels, lungs, and brain, of debilitated patients, who 
have long maintained the dorsal decubitus. Long standing 
or sitting may produce engorgement of the hemorrhoidal 
veins and of the uterus in feeble women. 

Dropsical effusions vary in quality with the state of the 
vessels and the blood from which they are effused; if the 
parieties of the vessels are lax and the blood impoverished 
and hydremic, the effusion will be decidedly serous ; if the 
walls of the vessels offer more resistance to the exosmotic 
influence, and if the blood contains nearer its normal amount 
of protein constituents, the effusion will be more albuminous. 

In some forms of debility, as chlorosis, in which the cor- 
puscles only are diminished, there is no dropsical effusion. 
When dropsical effusions depend upon organic lesion of the 
heart or kidneys, or occlusion of a vessel produced by the 
pressure of aneurismal or other tumors; to evacuate the 
effusion would only be as bailing a sinking ship, while its 
shattered hull is still drinking in the inexhaustible tide. 
But in dropsical effusion depending upon atony of the ves- 
sels and a hydremic state of the blood, eliminating medicines 
followed by tonics afford the most rational treatment. Nor 
in the former cases should eliminants be withheld, as their 
effect is palliative. Eliminants act by being absorbed into 
the blood, and passing through the secernent organs augment 



82 GENERAL PATHOLOGY. 

their secretory action ; but some of the emunctories have 
peculiar affinities (if I may so speak) for particular elimin- 
ating agents. Thus, the kidneys are specially influenced 
by the terebinths; the intestinal glands by elaterium, etc. 
Mercury is peculiarly directed to the liver, but it sensibly 
increases the secretory action of the entire glandular system. 
Reasoning, a priori, I would suggest that mercury thrown 
into a torpid secretory system, and failing to arouse its 
action, would very readily salivate. 

To three of the most active emunctories is confided the 
office of eliminating from the system the three principal 
organic elements, viz., carbon, hydrogen, and nitrogen ; the 
lungs mainly exhale the carbon, the liver elaborates fat and 
sugar from the hydro-carbons, and the kidneys take out the 
nitrogen ; the skin and intestinal glands are effective coad- 
jutors. 

In selecting emunctories for the elimination of dropsical 
effusions, we should demand most of the organs which in 
that particular case have the most ability to perform ; but 
not "work one organ down" by addressing all our treatment 
to it. 

Particularly I demur to the practice of goading congested 
kidneys with stimulating diuretics ; and, for similar obvious 
reasons, reprehend the practice of irritating an inflamed 
liver with cholagogues. 



ACTIVE CONGESTION. 83 



CHAPTER VII. 

ACTIVE CONGESTION — RESULTS — REMEDIES. 

Active congestion is the most important element of disease. 
Physiological determinations of the blood are common, and 
are even necessary for the healthy action of various organs, 
as the brain in thought, the uterus in gestation; but no 
physiologist will say that these are diseased or abnormal 
actions — as the brain is the throne of reason, and the uterus 
is the chamber of gestation. There is, then, no hiatus 
between these normal actions and active congestion in its 
literal and proper acceptation — a local hyperemia superven- 
ing upon some offending irritant — an element of disease 
varied in its phenomena and unfriendly in its results — 
inflammation. I use the term "active congestion" as synony- 
mous with inflammation, and in preference, because it 
conveys a definite idea — it is expressive of itself — it is the 
prime element of all the results of inflammation — it is 
inflammation per se; — while, on the other hand, the term 
"inflammation" is indefinite, is vague, and is the nucleus of 
confusion. 

Learned authorities have said that inflammation is active 
congestion with effusion. This appears to be as erroneous 
as the old definition of disease, which included with it the 
symptoms which it produces. It has been further asserted, 
and Prof. Bennett, of Edinburgh, particularly insists, that 
inflammation is exudation of the liquor sanguinis ; that is to 
say, inflammation is not inflammation till it reaches that 
degree of intensity which produces exudation. 



84 GENERAL PATHOLOGY. 

Active congestion may occur in some part, as the con- 
junctiva ; the capillaries are distended with arterial blood ; 
oxygenation is active, but there is no exudation — the inflam- 
mation has not yet attained a sufficient degree to produce 
it ; the protein constituent of the blood has not been oxy- 
dized and converted from a protoxide to a deutoxide and 
thrown out as an exudation : yet it is inflammation, and if 
it be allowed to proceed, it may go through its several grades 
and effect its various results, as exudation, suppuration, 
ulceration, etc. To assert the contrary, would be as arbitrary 
as to say that a child is not a human being. According to 
such fallacy, a burning mountain contains no fire unless it 
is throwing out the products of combustion ; but if lava be 
upheaved, the oxydation which produces it is of no import- 
ance, but the lava is a volcano. Again, epilepsy would not 
be epilepsy even when the petit mat is present. Wonder if 
it would be epilepsy when the grand mat comes like the 
thunderbolt of Jove ! 

Dr. Bennett is deserving of great respect for his learning 
and for the many sensible things which he has written ; but 
his ideas of active congestion appear to be defective. They 
may be supported by some strange law governing the animal 
economy in Scotland ; but exudation is a product of inflam- 
mation in America. 

The causes which lead to active congestion are varied and 
numerous. They may be general or local, mechanical, 
chemical, or vital — anything capable of producing irritation 
or interrupting the circulation of oxygenized blood. Intense 
and long continued cold, violence, the application of vesicants, 
are common and familiar causes ; or the offending irritant 
may be produced or introduced into the blood — as the 
animal poisons in the blood {zymosis) and the materies morbi 
of typhoid fever often irritate some of the delicate structures. 
Thus, the glands of Peyer rarely escape congestion, and often 
suffer ulceration, while they are industriously eliminating 
that irritating material from the blood. I believe that the 



ACTIVE CONGESTION. 85 

frequent supervention of pneumonia upon typhoid fever is 
referable to this cause. Again, the frequent occurrence of 
dysentery, when the spleen is large and congested, is per- 
haps referable to obstruction of the flow of the blood through 
the splenic artery. 

All eruptions upon the skin are so many congestions pro- 
duced by irritants in the blood. The dark red spots which 
sometimes appear on various portions of the skin, after the 
use of iodine, are characteristic. Infants very commonly 
have some kind of a rash, because their skin is so delicate 
that the least irritant in the blood irritates it. 

Whatever cause may influence active congestion, the first 
impression produced on the capillaries is contraction of their 
walls; their power of contractility depends upon fusiform 
cells (Lister), which possess elements closely allied to the 
fibres of the involuntary muscles. These cells may be tem- 
porarily influenced by impressions made through the nervous 
system ; this is illustrated in the color of the face when sud- 
den impressions are made on the mind. This, however, 
can only be momentary. The preliminary contractions 
even in the presence of an irritant, cannot continue long 
until those contractile cells become exhausted. They are 
now feeble and are densly crowded with blood fresh from 
the lungs, with its red corpuscles loaded with oxygen. Now 
commences the oxygenation of the nutritive lymph ; and 
this process so far controls the phenomena and results of 
active congestion, that some eminent authorities have said 
that inflammation is oxydation, and with much more plau- 
sible reasoning, too, than has been produced to prove that it 
is exudation. 

The first product of active congestion is serum ; then 
liquor sanguinis, adhesion, suppuration, hemorrhage, ulcera- 
tion and gangrene. Active congestion may disperse before 
it produces any of these results ; or it may proceed till it 
has produced one, two, three, or even all of them. The 
serum first effused will be absorbed if the congestion be early 



86 GENERAL PATHOLOGY. 

discussed ; but if the serum be succeeded by liquor sangui- 
nis of sufficient vitality, molecular blastema are constituted 
(Bennett), in which cell-growth is established. I believe if 
these cells develop precociously, they soon perish as pus; 
but if favored with longevity and conducive circumstances, 
they partake largely of fibrin, become plastic, and form false 
membranes and adhesions. But the exudation may be of 
low form, and incapable of organization or vital activity. In 
this way tubercles are perhaps formed; or it may be dis- 
solved and absorbed, resulting in resolution. There may be 
gradual disintegration of the tissue without being compen- 
sated with plastic material — deficient nutrition of the part ; 
this is ulceration. Finally, the exudation may be vitiated 
by constitutional taint or atmospheric contaminations, or in 
some way changed by chemical action, so as to give rise to 
gangrene and all the degrees of mortification. Hemorrhage 
is liable to occur at any time of the entire process. I have 
observed that in gun-shot wounds it is most liable to occur 
as late as twenty or twenty-five days after the injury is 
received, but may occur sooner or later than this. 

The symptoms of active congestion are numerous; they 
vary with the degree of congestion, with the length of time 
it has existed, and particularly with the kind of tissue in 
which it is situated. Heat, pain, redness and swelling are 
the symptoms and signs upon which this disease is usually 
diagnosed : they are direct consequences of the congestion, 
and are of necessity usually present as a group or in part ; 
but these are ever varying, and each kind of tissue has its 
peculiar structure and its characteristic pain : thus paren- 
chymatous structure, as the lungs give but little pain, because 
the effusions have sufficient room, and are not impacted 
against the nerve fibres. The converse is true of the serous, 
synovial and fibrous tissues : here the tissues are dense, and 
the pain is acute and intense. Therefore, if the dull pain of 
pneumonia is unfelt in consequence of violent, lancinating 
pain in tne chest, we rationally refer the latter to the pleura. 



SYMPTOMS AND SIGNS. 87 

The pain of dermal tissue is a burning sensation, as in 
erysipelas. On a line where the skin unites with the mucous 
membrane pain is intense and annoying, as a furuncle about 
the external nares, or a hordeolum on the margin of the eye- 
lid. The pain is sometimes referred to a part far distant 
from the site of inflammation, as from the hip to the knee, 
from the bladder to the testes, from the urethra to the instep. 

Lastly, this symptom may be absent even in acute inflam- 
mation ; it is often absent when the disease is chronic. 

Hyper-esthesia — excessive sensibility, or tenderness to the 
touch — is eminently diagnostic of inflammation. It is nearly 
allied to pain, and is even more characteristic. In some 
instances it is the main evidence upon which we determine 
the existence and location of inflammation. Pressure in the 
right illiac region is our surest means of determining the 
condition of Peyer's glands in typhoid fever. We often 
resort to palpation of the os uteri in order to determine its 
condition by the presence or absence of tenderness. 

Heat is generally present, because there is more than a 
normal supply of arterial blood, attended with active oxyda- 
tion in the part. It is lost to us as a symptom or sign when 
the inflammation is seated within the thoracic or the ventral 
cavity. When it is situated near the surface, often heat can 
not be felt because of intervening exudations. 

Redness when present is some aid in diagnosis, but it is 
often absent, and is of but little value, because the color of 
inflammed surfaces is so far modified by the varieties of struc- 
ture and by the stage to which the disease has attained. 

The swelling depends upon the hyperemia, and is aug- 
mented in proportion to the quantity of effusion produced 
and poured into the involved and adjacent tissues, and the 
capabilities of these tissues to receive it. Thus cellular 
tissues, as the eyelids and their adjacent structures, become 
much swollen from slight causes; while the denser struc- 
tures, as the tendons and the serous membranes, are too 
impervious to receive the effused fluids, and therefore never 



88 GENERAL PATHOLOGY. 

become swollen to a great degree. Finally, the functions of 
the parts involved are impaired or suspended. Motion is 
painful, sometimes too intolerable to be borne ; heightened 
sensibility remains until cicatrization is complete. 

Fever is chief of the constitutional symptoms ; its grade 
is dynamic, its type is continued ; but it always abates with 
the local changes upon which it depends. The abatement of 
the fever is often the first tangible evidence we have of the 
resolution of an acute inflammation ; hence the fever is 
eminently prognostic. On the other hand, it is highly 
diagnostic when shivering is succeeded by hot skin, bound- 
ing arteries, and accelerated circulation, with diminished 
secretions ; and if this state continue forty hours or longer 
without intermission or remission, we confidently predicate 
the existence of active congestion of some organ or tissue of 
the organism. Its precise locality is determined by intelli- 
gently applying to our senses all the symptoms and signs 
heretofore mentioned. 

This essay being designed with a view to brevity, I have 
not space to mention here the various other means of know- 
ledge to be brought to bear in making a correct diagnosis. 
It may suffice to say, that the normal structure and physio- 
logical functions of the various organs should be compared 
with their present condition. With all the known means, 
it is prett}^ easy to determine the location of this morbific 
element. The state of the pulse is indicative ; the difference 
is obvious between the full, resisting pulse of pneumonia 
and the accelerated, small and compressible pulse of enteritis. 
The fever appears to depend upon the increase of lymph 
globules — coagulated lymph — deutoxyd of protein, — which 
stimulates the heart to accelerated action. This view has 
been sustained by Prof. Linton, in whose learning and con- 
tributions to science every American has cause for just 
pride. Then there is increased oxygenation, which doubles 
the amount of oxygen in the protein constituents of the 
blood, which now becomes an irritant and stimulates the 



SYMPTOMS AND SIGNS. 89 

heart to energetic activity. The pulse is accelerated — there 
is fever — excitement and discord prevail — the nutritive 
element is out of balance — each of the various organs and 
tissues of the organism (as the people of a city are to the 
market) is dependent upon this nutritive element for the 
material to supply their various wants and to compensate for 
their continual disintegration. But the current is frantic — 
there is no regular supply — there may be over- abundance of 
blood in one part and famine in another; some of these 
integral citizens get too much of what they want, others get 
what they don't want, others perhaps get nil. Meantime the 
rapid transit of the blood through the secreting organs 
prevents them from taking out of it those effete materials 
which are damaging to the system. These materials are on 
their way to the vast expanse of the inorganic kingdom to 
become a part of the inorganic world, or to enter into new 
relations and again form a part of an animal or an humble 
plant. But there is no exit — the doors are closed — the 
secretions are locked. 

May I be pardoned for being tempted, for a moment, into 
this inviting Eden. But what more for this general disturb- 
ance? There is excitability and great restlessness; pains 
and aches come up from different parts. The irritant in 
the blood will explain some of these; the very indefinite 
term "sympathy" is often used to explain some of these 
pains and other phenomena not readily accounted for. 
What then is their true rationale ? It is the existing lesion 
of nutrition — this irregular supply of the nutritive material 
to the demands of the various parts. 

So much for the phenomena of symptomatic fever ; but it 
has other concomitants. It is apt to be ushered in with a 
cold surface and shivering : this indicates the contraction of 
the capillary system, which we noticed as being precedent 
to a local hyperemia. Here all the superficial capillaries 
contract at once, as if by instinct they were fortifying against 
the gushing torrents of the approaching pyrexia. 
7 



90 GENERAL PATHOLOGY. 

The varieties of active congestion are as numerous as the 
degrees to which it may attain, the causes that may produce 
it, and the constitutional predispositions and the circumstan- 
ces surrounding the individual in whom it may occur. Thus, 
it is acute if it runs a rapid course ; if it continues three or 
four weeks, it is sub-acute ; when it continues longer than 
this, and does not tend to an early recovery, it is chronic ; if 
it attacks the robust and plethoric, it is sthenic ; if it attacks 
those who are weak and anemic, it is not apt to produce so 
much constitutional disturbance — this is the asthenic variety. 

Again, inflammation is divided into two grand varieties — 
common and specific. This distinction is of much practical 
importance ; it is always desirable to make a proper discrim- 
ination betwen them. Common inflammation is that which 
occurs from ordinary causes, and is not modified by consti- 
tutional taint or specific virus ; for this reason it is the more 
amenable to treatment. The specific variety is that which 
depends on specific causes ; oi this variety are all the zymotic 
diseases, such as Malignant Pustule, Syphilis, Frambesia, 
Variola, Glanders, Scarlatina, etc. Indeed, the catalogue of 
specific inflammations is too long to be mentioned in full 
here. Some of these specific diseases which have been 
introduced into the system by animal poisons, as syphilis, 
and many that are not so introduced, as gout, often exist 
long in the system in a latent state, forming what we call a 
diathesis ; hence we speak of the syphilitic, the rheumatic, 
the erysipelatous, and the strumous diatheses. 

The prime element in most of the above forms of specific 
disease, is germ or baccillus, variable in kind and char- 
acter. 

If inflammation be produced by any cause, whether idio- 
pathic or traumatic, in a system where one of these diatheses 
is present, it will act in concert with, and bestow its own . 
type and peculiar phenomena upon, the new malady. Each 
specific element produces results peculiar to itself: thus, if 
you inoculate two individuals, one with an atom of syphilitic 



OBSERVATIONS. 91 

virus, the other with a globule of pus from a small-pox pus- 
tule, you get specific results ; each produces its kind. But 
if the two species of virus be inoculated* in the same person, 
the result will be small-pox and syphilis, but there will be a 
blending together; each one will be modified by the other, 
as in idiopathic disease, modified by a diatheses, and vice 
versa. This law governs vegetable life as well. If the seeds 
of a melon and a pumpkin be planted in close proximity, 
their products will be blended together ; each will partake 
of the nature and qualities of the other. These phenomena 
harmonize with the great fundamental truth, that an organ- 
ism, whether an animal, a plant, or a primordial cell, is not 
in a state of isolation, but is intimately connected with the 
whole organic series. The blending of a higher with a lower 
organization may favorably modify the latter at the expense 
of degeneracy to the better organization. 

Observations. — The varieties and modifications of this 
morbific process are too multifarious to be enumerated. In 
some variety, form, or degree, it either complicates or forms 
the prime element of almost every ill incident to the human 
race. It is not the fabled club of Habib, but it is the bane 
of our mortality. It is with this that we have most to do, 
most to suffer, and of this, albeit, we shall most all perish ! 
This element includes within its wide range very nearly all 
diseases — most all with which fatality is connected at any 
rate. He who traces it through all its varieties and modifi- 
cations, and writes a faithful elucidation, demonstrable in 
the light of science, of all its varied phenomena, will con- 
tribute to the profession the best w T ork ever written on the 
subject of medicine. Volo, non valeo. 

Treatment. — Manifold are the indications liable to be pre- 
sented by a malady so varied in its causes, its site, and in its 
complications. 

The writer believes that the couch of the sufferer is the 
proper place to perceive the indications and consider the 
treatment of all diseases. The principles of general treat- 



92 GENERAL PATHOLOGY. 

ment may be given here. The first indications are such 
means as are calculated to discuss or diminish the local 
hyperemia. This may be done by cold applications and 
revulsives. Sometimes the local abstraction of blood by cups 
or leeches is serviceable. Elevate the affected part so that 
gravitation will retard the flow of blood through the arteries 
leading to the congested part, and facilitate the recession of 
blood through the veins. If the brain is the suffering organ, 
active and free purgation is urgently demanded ; its modus 
operandi is mainly revulsive. But purgation is neither so 
effective nor so well borne if the disease is seated in the 
lungs. Free purgation is not admissible in enteritis. Warm 
fomentations should be applied over the chest or bowels 
when active congestion is seated in any of the viscera of 
these cavities. This application is peculiarly useful in re- 
lieving the pain of enteritis, peritonitis, pleuritis, nor is it less 
serviceable in relieving the pain and dyspnea of pneumonia; 
it relaxes the small tubes and allows a free ingress of air ; 
also, by relaxing the walls of the capillaries, their calibre is 
increased, and the blood which distends them is afforded a 
more ready exit. Warm fomentations promote the absorp- 
tion of effused fluids. Further, according to Prof. Bennett, 
the warmth and moisture which they impart often prevent 
that chemical decomposition of the exudation which pre- 
cedes gangrene, and that highly plastic organization which 
forms fibrinous membranes, by hurrying the exudation to 
the growth of pus cells which are soon broken down, dis- 
solved, taken into the circulation, and through the emunc- 
tories excreted from the system. 

Sinapisms are useful appliances over the region of the 
congested organ. The most effective means of arresting an 
inflammation, particularly after the stage of excitement has 
passed, is the fly-blister. If the disease is in the chest or 
bowels, it should be applied directly over the suffering organ, 
and should be of ample size. If the disease is situated 
within the cranium, the blister should be applied to the back 



REMEDIAL MEASURES. 93 

of the neck (not on the head, as in days of yore). If inflam- 
mation is in the eye, a blister should not be placed nearer 
than the temple. In all cases the circulation must be kept 
in equilibrium. Anodynes may be used to allay pain and 
morbid vigilance. Patients may generally drink cold water, 
ad libitum. Diet should be sustaining, composed of milk 
and nutritious soups. Alcoholic stimulants should be ad- 
ministered on the first indication of the vital powers to flag, 
particularly if the pulse becomes small and frequent, or the 
body cool and damp. When we were examining inflamma- 
tion from a pathological standpoint, it must have been per- 
ceived that it is a disease of debility, and that the attendant 
excitement is not an evidence of strength, but of an irritant 
in the blood and of deranged circulation. Then we should 
rather foster than diminish the vital power. If, however, 
the heart's action is excited into a rage, and the blood is 
moving in the arteries in frenzied torrents, threatening a 
new nidus for its burning element, or a gushing hemorrhagia, 
sedatives should be administered. Nauseants and nitrate 
of potash may not do here ; the verat. viride is best adapted 
to relieve the condition above described, but its use should 
cease with the inordinate excitement. General blood-letting- 
is an old custom and an old evil. Many confiding patients 
has the lancet sent to a premature grave. The author 
never opened a vein to cure or ameliorate disease by the 
abstraction of blood, and has no reason to regret it. Mercury, 
used in moderation, appears to be useful in the early stage 
as a deoxydizing agent. It is particularly useful if the 
secretory system is torpid, and if the eyes present a muddy 
tinge, or the skin an icterode hue ; but its use should be 
cautiously limited. Salivation should be avoided ; it does 
no good, but much harm. That mercury promotes the 
absorption of exudation, or favorably modifies it, is extremely 
doubtful. Its use for such purposes retards, rather than 
facilitates, a successful issue. Tartrate of antimony has had 
its day, and now stands justly condemned. Diuretics and 



94 GENERAL PATHOLOGY. 

diaphoretics should be administered, particularly after the 
stage of excitement has passed. The spirits or oil of tere- 
binth promotes various secretions, and is a special auxiliary 
to the kidneys in removing from the blood the abundance of 
effete material resulting from the oxydation and waste of 
tissue. When the disease is chronic, depletants should be 
particularly abstained from. The system should be sus- 
tained by tonics, stimulants and nourishing diet. Counter 
irritation is especially useful here as in the acute stage. The 
diathesis or the cachexia, if any, should be considered in 
directing treatment. Whatever may have caused the in- 
flammation, if the diathesis is strumous, prescribe iodine,, the 
iodides, fresh milk, and cod liver oil. If the cachexia is 
syphilitic, it demands the iodides, burdock, and the ferrugi- 
nous preparations. If the diathesis is rheumatic, it indicates 
colchicum and the iodides. Frequent baths or ablutions of 
the entire surface of the body with tepid or cold water are 
eminently useful in all these chronic diseases. 

Inflammation caused by wounds and injuries has some dis- 
tinctive characteristics, and demands some special consider- 
ations. The lesion of structure produced by a mechanical 
cause is a source of continued irritation ; when produced by 
a blow or missile, there is much contusion and corresponding 
waste of tissue. It further differs from idiopathic inflam- 
mation of internal organs, in this : that the wound often 
presents a large external surface which must cicatrize by 
granulation under the irritation and varying temperature 
of the atmosphere. In recent wounds, hemorrhage, if it 
exist, should be arrested ; the wound should be thoroughly 
cleansed of everything foreign or capable of keeping up 
irritation by free ablution with hot water — carbolized, care 
being taken to remove all clots of blood, spicula of bone, 
gun-wadding, etc. The dressing should be very light and 
unirritating ; the best dressing is iodoform, then a piece of 
clean linen saturated with carbolized water, and applied 
loosely to the part. If in the suppurative stage the wound is 



REMEDIAL MEASURES. 95 

not kindly disposed ; if it is pouring out ichor — a thin acid 
pus — emolient cataplasms are often of service. The wound 
may be washed with a weak solution of hydro-chloric acid? 
or of some of the chlorides ; the acrid pus must be frequently 
removed. But if the wound is discharging laudable pus, that 
is, a thick, white cream -like, non-irritating pus, it should 
not be disturbed. When removed at all, it should be at 
long intervals, and with the mildest ablutions. This pus is 
nature's poultice ; under it the plastic exudation is organiz- 
ing cells for the repair of the lesion — reconstruction is pro- 
gressing most desirably. It is manifest that the frequent 
washing of a wound in this condition is not only useless but 
injurious; it retards the reparative process by destroying 
the cells or the covering which protects them. Continued 
destruction to cells, as often as they form de novo, may not 
allow sufficient repair to compensate for the waste of tissue 
in the part ; hence ulceration is a frequent consequence of 
such procedure. 

This brief allusion to wounds is made in the guidance of 
pathology, and corroborated by the ample observations made 
by the writer in extensive military hospitals. 



96 GENERAL PATHOLOGY. 



CHAPTEK VIII. 



PATHOLOGICAL CHANGES IN THE PROXIMATE PRINCIPLES OF 

THE BLOOD. 

We now proceed to notice such pathological elements as 
consist in morbid changes in the proximate principles of the 
blood. This important organic fluid is composed of red 
corpuscles, white or colorless corpuscles, fibrin, albumen, 
combustive matters, saline materials, and water. The blood 
corpuscles are formed in the spleen and in the lymphatic 
glands. It appears that these corpuscles, when first formed, 
are all colorless, and that a majority of cells, after circulating 
for a brief period as white corpuscles, suffer solution of 
their walls, when their nuclei are set free and are converted 
into red corpuscles. These red corpuscles exist in the blood 
in health in the proportion of 130 parts to the 1,000, and 
vary in disease from 27 to 180 parts. They exist in some 
greater proportion in the blood of males than in that of 
females, and are present in great abundance in foetal and 
infantile life. 

A red corpuscle consists of a delicate covering or sac, 
containing two peculiar chemical principles in a fluid state, 
known as globulin and hsematin. The globulin is in much 
the greater proportion, and is almost pure albumen; the 
hsematin contains largely of iron, phosphorus and potash, 
and appears to give to the globule its peculiar red color. A 
knowledge of the component elements of these corpuscles 
explains why it is that a due proportion are so essential to 
the nutritive process; and as they are carriers of oxygen 



CHANGES IN THE RED CORPUSCLES. 97 

from the lungs to all parts of the system, they appear to be 
the element of the blood upon which all the energies of life 
mainly depend. 

The red corpuscles may be increased, diminished or altered 
in their condition or composition. When their proportion 
is increased to any considerable degree, their vivifying 
influence, consequent mainly on the abundance of oxygen 
which they carry, stimulates the heart, and, indeed, all the 
organs of the system, to increased energy ; so that there is 
increase of animal heat and exaltation of all the functions of 
life. This condition may be produced by excessive indul- 
gence in rich food, combined with such measures as promote 
the processes of digestion and assimilation, and its presence 
is indicated by florid lips, blushing cheeks, and excited 
functional activity. 

The red corpuscles are diminished by deficiency of food, 
exposure to impure air, and by all influences capable of 
producing digestive derangement; also by over-exertion, 
and by hemorrhage and other exhausting drains from the 
system. This principle of the blood is diminished either 
primarily or secondarily in all affections attended with 
debility or exhaustion of physical power, as typhoid fever 
and in all the grades of continued fever, in chlorosis, tuber- 
culosis, scorbutus, and suppurating wounds. The long 
continued action of mercuiy, lead, antimony, or colchicum, 
upon the system rapidly destroys the red corpuscles and 
retards their formation. The signs of deficiency of this 
element of the blood are but the familiar signs of anemia : 
the skin is blanched or sallow, the lips pallid, and the 
muscles flaccid and deficient in power. 

Change in the state or quality of these corpuscles is a prolific 
element of disease. These qualitative changes in the red 
corpuscles give character to some of the most grave forms 
of continued fever. In the malignant grades of typhoid 
fever, there is breaking down or solution of these corpuscles, 
and their coloring matter (hgematin) is lodged in patches in 



VO GENERAL PATHOLOGY. 

the subcutaneous tissue, or it paints the cutis vera in spots. 
Hence, we find upon the skin the rose-colored spots, the 
purple petecchise, and the vibices with their long, dark 
stripes resembling ecchymoma, thus presenting the various 
shades of color that the coloring matter of the corpuscles 
undergoes under some peculiar morbific influences. 

A grade of continued fever of the typhoid type occasion- 
ally prevails in some of the Western States. It is charac- 
terized by an unusual abundance of rose-colored spots, and 
has therefore been erroneously denominated "spotted fever." 
Some practitioners have observed some isolated cases in 
which the brain or spinal cord suffered as a natural conse- 
quence, but perhaps to an unusual degree, and hence the 
name cerebro-spinal meningitis has been applied to this 
essential fever in some circles. In those cachetic conditions 
of the system common to the advanced stages of scorbutus 
and syphilis, the cachemia appears to consist in diminution 
of the red corpuscles, and perversion of their constituent 
principles, and in the latter affection the blight is the effect 
of a septic poison in the blood. But in both of the last 
mentioned affections we find upon the skin, respectively, the 
dark and the copper-colored spots characteristic of the mor- 
bid solution of the red corpuscles of the blood. Blood that 
has long existed in a state of stasis in any part of the body, 
as in chronic congestion of some organ, becomes deteriorated 
or "spoiled," and as it is received back into the circulation 
it contaminates the whole volume of blood. This corrupting 
touch is particularly destructive to the red corpuscles. Observe 
the familiar instances of congestion of the womb unrelieved 
by the wonted catamenial flow, and the attendant chlorosis 
consequent on the contamination and destruction of the red 
corpuscles by the blighting influence of blood that has 
remained long at rest in the minute uterine vessels. 

All malarious districts furnish examples of enlargement 
and congestion of the spleen, and consequent vitiation of the 
blood, which diminishes the proportion of red corpuscles, 



CHANGES IN THE RED CORPUSCLES. V\) 

both by the destruction of many of those already formed, and 
by rendering the white corpuscles incapable of undergoing 
the metamorphosis necessary to their generation. This 
disproportion between the white and the red corpuscles of 
the blood is consequent on long continued congestion of any 
of the textures of the system, but it is greatest and most 
remarkable when it is the result of congestion of the spleen, 
or other organs or bodies denominated lymphatic glands, for 
the reason that these are evidently the organs in which the 
colorless corpuscles are formed. The state of the system 
above described in which the white corpuscles are largely 
increased at the expense of the red ones, has been denomi- 
nated leucocythemia. 

Granular disease or other lesions of the kidneys altering 
their secretory function, and causing a profuse drain of 
albumen from the blood, diminishes the red corpuscles by 
depriving them of albumen, which is their natural protection. 
In jaundice these corpuscles suffer diminution evidently in 
consequence of the presence of bile in the blood. It is man- 
ifest that whatever influences contaminate or diminish the 
red corpuscles of the blood, produce oligemia and cachemia. 

The red corpuscles are living cells; each one is a com- 
plete organism, each has alloted to it a definite period of 
existence, or a natural life-time; subject, however, as we 
have seen, to the deleterious influences of morbific agencies. 
Much curiosity prevails to know in what organ of the sys- 
tem, or on what portion of their journey, these little pilgrims 
meet their death, and what disposition is made of them at 
the close of their brief career ; for it is a curious fact, that 
in a living human body millions of them die every minute. 
Some eminent authorities maintain that they are all de- 
stroyed in the liver, while others assert that their final 
destruction takes place in the spleen, and there are yet others 
who affirm that they suffer dissolution as they travel the 
rounds of the circulation ; and it does appear most probable 
that they are dissolved in the fluid in which they circulate, 



100 GENERAL PATHOLOGY. 

and are converted into fibrin, or separated from the blood in 
its passage through the liver, and afterwards appear as a 
constituent part of the bile. 

The Treatment of excess of red corpuscles in the blood 
requires but a brief notice here. In this comparatively 
feeble and disease-stricken generation, this state of the system 
is of so rare occurrence that it seldom requires a resort to 
prophylactics or to the aid of the physician. When these 
corpuscles become so abundant as to be incompatible with 
health, it becomes necessary to diminish them by retarding 
their formation ; and in order to this, efficient agencies are 
numerous. Low diet and occasional purgatives are usually 
sufficient as medical agents. Blood-letting, mercury and 
antimony destroy the red corpuscles rapidly, but it is obvious 
that their effects would be worse than the disease. 

Deficiency of red corpuscles is an* important element of 
disease, mainly in consequence of the great frequency of its 
occurrence, as it presents itself primarily or secondarily in 
every affection that is attended with considerable severity. 

Remedial measures readily suggest themselves, and act in 
a comprehensive manner : moderate exercise in, or exposure 
to, a pure, bracing atmosphere ; free indulgence in the use 
of food rich in nutritive material ; the moderate use of pure 
wine or brandy ; the bitter tonics and mineral acids ; and, 
above all, iron in some soluble form. Any preparation of 
iron should be taken soon after a meal, so that it may 
mingle with the aliment in the stomach while it is under- 
going digestion, in consequence of which it will be more 
readily assimilated to the blood. 

The qualitative changes in the red corpuscles, heretofore 
noticed as constituting grave elements in some malignant 
febrile affections and other cachetic conditions of the system, 
require such therapeutic interference as is calculated to 
cleanse the system ancf rid the blood of the diseased and 
decaying corpuscles, and to promote the formation of healthy 
cells to compensate for the loss sustained. In order to 



COAGULATION OF FIBRIN. 101 

accomplish these objects, the skin, kidneys, and all the 
emunctories, should be kept in the active exercise of their 
respective functions, and the bowels should be encouraged 
to as active operations -as the system is well able to bear; 
always, however, avoiding frequent alvine evacuations, and 
all other debilitating measures, when the tendency is to 
prostration. Where the slightest tendency exists to the latter 
condition, the skin and kidneys may yet be kept active, 
but the bowels should be restrained to a merely soluble con- 
dition. Tonics, stimulants and nutritives should be ad- 
ministered, and a sustaining treatment should be observed 
throughout. 

Fibrin. — This substance is nearly allied to albumen, and 
exists in the chyle, lymph and blood ; in healthy blood it is 
present in the proportion of about 3 parts in every 1,000. 
Fibrin, like albumen, has a protein nucleus, and may exist 
in a soluble or insoluble state. It is richer in nitrogen than 
albumen, and it also contains one chemical equivalent more 
oxygen, and is therefore a deutoxyd of protein ; but its dis- 
tinguishing characteristic is its tendency to organize, which 
gives to the blood the property of coagulability. Its coagu- 
lation is the agglutination of fibrils which form meshes, in 
which the cells are entangled and arrested, thus augmenting 
the accumulation till a clot is formed. 

When the fibrin coagulates without receiving the cells in 
its meshes, as when they sink down in the vessel below the 
fibrin, the clot of course does not present its usual red color, 
but a brown or buffy hue, and has therefore been called the 
"buffy coat" ; and, in the absence of cells, the fibrils meet 
with less resistance and contract to a greater degree, so that 
the edges of the clot or coagulum become raised, forming a 
basin-like concavity. The important practical deductions to 
be derived from these considerations will be most apparent 
when contrasted with the doctrine formerly held, that the 
buffy coat is pathognomonic of inflammation, and thus the 
lancet was wielded with remarkably fatal consequences. 



102 GENERAL PATHOLOGY. 

Fibrin exists in greater quantity in arterial than in venous 
blood. It furnishes material for the formation, growth and 
repair of certain tissues ; it acts as a shield of protection # to 
the red corpuscles in the circulating current, and it obviates 
the tendency to effusion of blood and serum through the 
walls of the vessels and from the capillaries, and retards and 
limits the flow of blood when it escapes through accidental 
openings in the vessels. 

Increase of fibrin is a natural result of hyper-oxygenation, 
and accordingly we find it in excess in most all of the in- 
flammatory affections, and especially in those of the sthenic 
variety. Inflammation appears to give rise to the greatest 
amount of fibrin when it occurs in fibrinous textures, as in 
the periosteum, muscles and sero-fibrous membranes. This 
view is supported by the fact that the greatest excess of 
fibrin is found in the blood of persons suffering with acute 
rheumatism, which especially involves these textures. 

Fibrin is generally in excess in phthisis pulmonalis, 
evidently in consequence of inflammatory results and com- 
plications. It is said to be in excess in anemia, though this 
is rather relative than real. It is an important fact that the 
fibrin increases during pregnancy, so that at the end of the 
gestative term it is usually in great excess, while most of the 
salts are deficient ; in this condition the blood is liable to 
coagulate in the vessels. These considerations explain the 
fact that a woman just relieved of her neonatus and the pang 
of parturition, upon assuming the erect position, before the 
nervous and circulatory system are restored to their proper 
balance, is in danger of the formation of "heart clot" — this 
is demotivus lapsus unheralded. 

Deficiency of fibrin is a mutation to which the blood is very 
liable. As the fibrin is diminished the blood becomes more 
fluid and less coagulable, so that hemorrhage and dropsical 
effusions are common consequences of this condition. Wounds 
and fractures are not readily repaired — the red corpuscles 
become deteriorated and the nutritive process is retarded. 



CHANGES IN THE FIBRIN. 103 

The fibrin is much diminished, or even totally absent from 
the blood, in typhoid and other adynamic grades of fever, 
which accounts for the frequent occurrence of epistaxis, and 
effusion of blood from the bowels. In purpura hemorrhagica 
the blood is deficient in fibrin, as also in cholera and in 
erysipelas. The last named affection is rather exceptional, 
as being an inflammatory affection in which the blood is 
deficient in fibrin ; here there is not a sufficient amount of 
this plastic material to form false membrane to cup in or 
contain the pus that is generated. So this suppurative matter 
is poured out among the adjacent tissues, and is guided in 
its travels only by the law of gravitation. It is mainly for 
this reason just stated that erysipelas, when it reaches the 
suppurative stage, is obstinate and difficult to control. 

Changes in the quality of the fibrin are produced by various 
circumstances and influences affecting its elaboration and 
plasticity. Thus, the use of food entirely vegetable, and the 
neutral and alkaline salts of potash and other alkaline sub- 
stances, retard the elaboration of fibrin, and diminish its 
coagulability and its plastic properties. When blood is drawn 
slowly, it coagulates more rapidly and less firmly than when 
it flows freely from a large orifice. The coagula of healthy 
blood are more dense and firm than those of diseased blood. 
The plasticity of fibrin does not depend upon its quantity, 
but upon its quality. 

This same substance that gives to the blood the power to 
coagulate, and composes the cup-shaped coagulum, is the 
lymph or plasma that heals wounds, reconstructs tissues, 
forms false membranes, and nourishes muscles. When the 
fibrin is healthy and possesses these plastic properties in a 
high degree, it is said to be euplastic; when the plastic 
properties are enfeebled by deficiency in its nutritive 
material, or in its inherent constitution, it is cacoplastic. In 
this condition it is only capable of imperfect or perverted 
organization, and leads to morbid growths or deposits, which 
may be of the most fearful character ; as cancer and tubercle. 



104 GENERAL PATHOLOGY. 

When it is totally incapable of organizing into living tissue, 
it is aplastic. In this state it may form ichor, or the aplastic 
lymph may putrefy and give rise to sloughing of the tissues, 
or moist gangrene. 

Excess of fibrin may be reduced by the use of sweet meats, 
alcoholic drinks, and such other agencies as tend to produce 
venosity of the blood. Mercury appears to diminish the 
amount of fibrin in the blood indirectly, by retarding the 
oxygenation of albumen and other protein principles, thereby 
hindering its formation. Evidently, if this drug defibrinates, 
it is because it first deoxydizes. The alkalies and nitrate of 
potash possess the properties of diminishing or preventing the 
coagulation and organization of fibrin in drawn blood ; but 
it has been doubted that they diminish the amount or the 
plasticity of this substance while in the system. Impeded 
respiration and excessive bodily exercise diminish the fibrin. 
Blood-letting withdraws the greatest proportion of red cor- 
puscles, and should not be resorted to as a means of reduc- 
ing the amount of fibrin. 

Remedies against deficiency of fibrin. — When the fibrin has 
been diminished by the presence of a septic poison in the 
blood, remedial measures should be at once directed with a 
view to its removal through the emunctories. The food 
should be rich in nutritive material and taken in as generous 
supplies as the digestive organs are capable of receiving and 
appropriating. Tonic medicines should be prescribed and 
their use persisted in till their effects are evinced by the 
reinstated crassment of the blood, and renewed strength and 
vigor of the system. 

Remedial measures calculated to improve the state of the 
blood, as respects the quality of its fibrin, are sometimes 
indicated. It would be difficult to restore health and plastic 
properties to aplastic and cacoplastic lymph. These states 
demand such remedial measures as were directed above 
for the purpose of increasing the amount of healthy and 
eu plastic fibrin. And in addition to these measures such 



CHANGES IN THE ALBUMEN. 105 

agencies are required as are capable of promoting the 
excretion of the aplastic and cacoplastic materials. For the 
elimination of these deleterious principles from the system, 
recourse should be had to diuretics and diaphoretics, of 
which turpentine, buchu and spiritus minder eri are the most 
eligible. The entire surface of the body should be washed 
daily with tepid water holding in solution chloride of soda. 

Albumen. — This principle exists in healthy blood in the 
proportion of about 70 to each 1,000 parts. Soda is usually 
peculiarly associated with it, and is present in the hepatic 
and splenic veins in the form of a neutral albuminate 
Albumen, unlike fibrin, is more abundant in venous than in 
arterial blood ; it is the nabulum of the cells and of all the 
soft tissues, and it gives to the serum a sufficient degree of 
spissitude to facilitate its motion within the vessels, and to 
obviate the tendency to hemorrhage and to effusion of the 
serum by exosmosis, and it protects the cells from the acri- 
mony of the salts. 

Excess of albumen is usually present in the acute stage of 
inflammator}^ affections, but to a less degree than fibrin. Its 
relative proportion is increased in cholera and in some forms 
of oligsemia, as in chlorosis, in consequence of the diminution 
of serum in the former, and of the red corpuscles in the latter. 

Deficiency of albumen is most likely to be induced by 
insufficiency of nutritive food, conjoined with colliquative 
discharges or exhausting secretions from the system. In 
some affections of the kidneys the blood is directly relieved 
of its albumen by the perverted action of those organs, but 
albumen is not liable to as varied qualitative changes as the 
other constituents of the blood. 

Remedies capable of reducing the quantity of albumen in 
the blood, are not often required as such ; and this remark 
applies as well to all the other solid or nutritive principles of 
that organic fluid. However, such agencies as diminish the 
quantity or impair the quality of all the protein constituents 
of the blood are sometimes necessarily enjoined, being posi- 
8 



106 GENERAL PATHOLOGY. 

tively indicated to meet some existing, but rarely occurring, 
emergency. Poor food and excessive bodily exertion are, of 
course, exhaustive to the albumen and to all the protein 
principles of the blood. The quantity of albumen in the 
blood may be increased by nutritive food, such as raw eggs, 
oysters, and rich animal soups, pure air, moderate exercise, 
and a well regulated condition of the digestive organs and 
of the processes of digestion, assimilation, nutrition and 
secretion. 

Combustive Materials. — Healthy blood contains an indefi- 
nite amount of fat, varying with the quantity and quality of 
the food, and with the degree of muscular action. It exists 
in greater quantity in the venous than in the arterial blood, 
and less in the blood of men than in that of women. The 
essential animal fats are of three kinds — oleine, margarine 
and stearine. These all contain largely of unoxydized 
hydrogen, and are therefore highly combustible, and are 
capable of evolving an intense degree of heat; but in the 
animal organism they are oxydized by a gradual process. 
For this reason, and that they are almost non-conductors of 
heat, they are important agents in producing and maintain- 
ing an equable temperature of the body. It is interesting 
to observe that the products of their combustion are car- 
bonic acid and water, and that these are the identical binary 
principles from which they arise. 

The quantity of fat in the blood is increased by free 
indulgence in food containing hydrogen and carbon in large 
proportions, as the flesh and particularly the fat of animals, 
and vegetables rich in starch and sugar. Sedentary habits 
and the use of malt liquors favor the production of an excess 
of fat in the blood, and the consequent development of 
adipose tissue — obesity. 

Excess of fat in the blood may also be produced by 
inflammation of the liver, or by such obstruction in the 
lungs as is capable of impeding respiration. Fat is always 
in excess in the blood when the svstem is affected with 



EXCESS OP COMBUSTIVE MATERIALS. 107 

mercurial salivation. It is an interesting fact that fat finds 
a receptacle in the system as the nuclei of many cells, and if 
the food is non-nitrogenized, so that the blood does not 
furnish a sufficient amount of azotized material to form cell- 
walls for these fatty nuclei, they are supplied by the mus- 
cular fibres, or remain in a free state in the blood. The 
amount of fat in the blood is diminished by all febrile 
diseases, by low diet, by most of the vegetable acids, and by 
all excessive secretions and evacuations. 

Sugar is a combustive substance fabricated by the liver 
out of the hydro-carbons which it receives from the blood. 
Starch is converted by the pancreatic and intestinal juices 
into sugar ; which is but a stage of its progressive metamor- 
phosis into lactic acid, and ultimately into carbonic acid and 
water, and these products of its final oxyclation are removed 
by the excreting organs. 

Sugar exists in the greatest quantity in the blood of the 
hepatic vein, on its way to the lungs ; and upon reaching its 
destination, and coming in contact with the oxygen which 
these organs are constantly receiving, it contributes its com- 
bustive elements to the production of animal heat, and does 
not pass on as sugar, except when it is generated in great 
excess, as in diabetes. 

M. Bernard concludes : that the liver first secretes a sub- 
stance resembling hydrated starch, called glucogene, which 
upon entering the blood comes in contact with a ferment, 
and immediately completes the formation of sugar, which 
upon entering the lungs is decomposed by the oxygen. 
Therefore, excessive action of the liver tends to increase the 
amount of sugar formed, and diminution of the quantity of 
oxygen received by the lungs prevents its decomposition. 

For these obvious reasons, diabetes is often associated with 
phthisis pulmonalis, and other affections of the lungs. 
These views appear to be substantially approved by such 
eminent pathologists as Bennett, Carter (of England) and 
Virchow. 



108 GENERAL PATHOLOGY. 

Mineral constituents. — The amount of inorganic matter in 
healthy blood is equal to a little more than eight parts in. 
a thousand. This estimate does not include iron, which 
is an important constituent in the red corpuscles. The 
inorganic constituents of the blood have distinctive charac- 
ters, and discharge various essential duties. The carbonate 
of soda confers alkaline properties on the blood ; the phos- 
phate of the same base gives to the serum the essential 
property of holding carbonic acid in solution, and thus it is 
conveyed from all parts of the system to the lungs to be 
exhaled. 

The phosphate of lime nourishes the bones and other 
osseous tissues; it enters largely into their structure, and 
gives to them hardness and friability. When this substance 
is in excess, as in aged persons, and in those who are ex- 
cluded from vegetable food, the bones become brittle because 
of disparity in the proportions of their animal and calcare- 
ous constituents. On the other hand, deficiency of this 
phosphate in the blood leads to softening of the bones, as 
exemplified in that singular affection known as mollities 
ossium, or rickets. Phosphorus and potash are respectively 
essential elements to the nutritive materials of nervous and 
muscular tissues. 

Chloride of soda exists mainly in the plasma ; when taken 
into the stomach it is decomposed, and forms hydrochloric 
acid and soda ; the former of these is appropriated to the 
gastric juice, and the latter to the bile. Chloride of soda is 
evidently continually being formed in the system by the 
union of its appropriate acid and base, and when in excess 
in the blood it causes the red corpuscles to crimple or con- 
tract, so that the}^ attract water rapidly from the blood and 
tissues by endosmosis, and hence the sensation of thirst 
arises as an indication of the deficiency of fluids. 

The saline constituents of the blood are deficient in all 
the malignant grades of continued fever, in cholera, and in 
the latter stage of pregnancy. In such conditions the indi- 



EXCESS OF WATER. 109 

cations for supplying these ingredients to the blood are 
obvious, and often urgent. 

Water usually constitutes rather more than three-fourths 
of the entire volume of healthy blood. It is an appropriate 
vehicle for the conveyance of the plastic materials to the 
various parts of the system, and for the removal of waste 
material and other deleterious principles from the body. 

Water, by its solvent properties, presents the nutritive 
material in a form easily appropriated to the wants of the 
tissues, and it dissolves the effete materials, and presents 
them to the excretory organs in a form that facilitates their 
expulsion from the system. 

The quantity of water in the blood may be increased at 
will by free indulgence in liquid drinks, or it may be dimin- 
ished by abstinence. In anemia, whether produced by the 
sudden loss of blood, as by hemorrhage, or by debilitating 
disease, the proportion of water in the blood is largely 
increased. In diseases reputed to be of malarial origin, as 
obstinate remittent fever, and chronic diarrhoea, the blood 
becomes decidedly watery — there is hydremia, with marked 
tendency to dropsical effusions. In our recent large armies 
all medical officers must have observed that hospitals and 
convalescent camps were often crowded with soldiers suffer- 
ing with the last named affections, and that almost all were 
anemic, hydremic and dropsical. Excess of water in the 
blood, which generally takes place at the expense of the red 
corpuscles, and other organic constituents, deranges the 
nerve centers, and gives rise to an obtuse state of the intel- 
lectual faculties, and to neuralgic pains, and cardiac palpi- 
tations, and bellows murmur heard loudest at the base of 
the heart, and propagated along* the course of the aorta. 
Diminution of water in the blood is consequent upon long 
continued abstinence from fluid ingesta, and is a secondary 
element in all diseases attended with profuse discharges of 
water from the system. 

Therapeutic agencies consist of measures calculated to 



110 GENERAL PATHOLOGY. 

eliminate water from the system when it is in excess ; for 
this purpose diuretics and hydragogue cathartics are often 
demanded. Of these classes of medicines, buchu, turpen- 
tine, elaterium and bitartrate of potash are generally the 
most eligible. These should be followed by iron and other 
tonics, to give solid constituents to the blood and tone to the 
general system. 

The water, when deficient, should be increased by the free 
use of liquid ingesta, and the arrest of all excessive drains 
of water from the svstem. 



IDIOPATHIC FEVERS. Ill 



CHAPTER IX. 



THE IDIOPATHIC OR ESSENTIAL FEVERS. 

Fever is both a symptom and a disease. As a symptom, 
it indefinitely comprehends a hot skin, quick pulse and sup- 
pressed secretions, which phenomena arise symptomatically 
in various forms of disease. But its more definite accepta- 
tion, and that of which I now design to treat, is a class of 
diseases consisting in various contaminations of the blood, 
and usually characterized by and denominated idiopathic 
Fever. These essential fevers are produced by a great 
diversity of causes, and are therefore dissimilar in their 
etiology and in their types; but the various species are 
analogous in these important characteristics, namely : they 
are each idiopathic, and they each consist in deterioration of 
the quality of the blood by morbific influences and agencies 
received from without or generated within the system. 

Then it is an important fact that the various species and 
grades of essential fever are but so many of the qualitative 
changes of the blood, and that the phlegmasia? and other 
supervening congestions evince the specific character of the 
polluting influence or agency, and as well do they attest the 
fact previously stated, that qualitative change in the blood 
leads to quantitative change, and vice versa. As a class of 
these essential fevers, and a sub-class of those qualitative 
changes in the blood, we shall notice first the major Exanthe- 
mata, comprehending by this term such affections as consist 
in a specific animal virus which renders them capable of 
propagating themselves, or of being communicated from one 



112 



GENERAL PATHOLOGY. 



person to another. Most of these affections are such as 
seldom occur more than once in the same individual ; and 
it is a distinguishing characteristic of each of them that they 
are usually accompanied by fever and by exanthematous 
eruptions, which may be in the form of erythema, rash, 
vesicles, or pustules. 

The following table exhibits the eruptive fevers according 
to their individual peculiarities and distinctive character- 
istics, and also the most marked types and grades of non- 
eruptive essential fevers : 



Eruptive. 



Essential Fevers. 


r Small-pox, 
Measles, 
Scarlatina, 


CD 


Parox- 
ysmal. 


Cow-pox, 
Mumps, 
Erysipelas, 
Glanders. 


S < 

CD 

i 

O 


^ 



Intermittent, 

Remittent, 

Yellow Fever. 

Febricula, 

Relapsing, 

Typhus, or 

Typhoid. 



Typhoid is allied to the eruptive fevers in some of its 
essential characteristics; thus it often, but not invariably, 
originates in, or arises from, a specific animal poison : 
besides, it is contagious, and is not unfrequently accom- 
panied by eruptions. But in the preceding table it is placed 
with the non-eruptive species of fever because it is peculiarly 
allied to them as evinced by the circumstances that even 
the higher grades of non-eruptive fever often terminate in 
typhoid. * 

Each of these eruptive fevers is quite distinct from the 
others of the same class in the essential character of the 
virus or the effluvia from which it arises. Each one is also 
peculiar to itself in its definite period of incubation, and in 
the mode of its development. On the other hand, they 
present many points of similitude: they each arise from an 
animal poison — they each run a definite course — each is 
attended by some form of eruption involving the skin and 



ERUPTIVE FEVERS. 113 

often the mucous membranes as well — each is accompanied 
by fever, and all are contagious ; so that to consider them 
together is but to observe the classification of nature. 

The symptoms and signs common to all of these eruptive 
fevers are successively malaise, shivering or rigor, pain in 
the head and back, fever, and eruption on the skin, with 
more or less efflorescence of the mucous membranes, 
especially of the fauces and pharynx, which often gives rise 
to severe angina. The edges and tip of the tongue are 
usually reel, and its center is covered with fur, through 
which red papillae project. 

What is the rationale of each of these phenomena? 
Evidently the malaise is the incipient effect upon the 
organic functions of the poison in the blood. But why the 
rigor and the fever? Are these extremes of temperature 
both produced b}^ a common cause — the presence of a poison 
in the blood ? We think so. The most learned and gifted 
pathologists have presented a contrariety of opinions and 
hypothesis respecting the rationale of heat in essential fever. 
The increased respiration and oxygenation of combustive 
materials evidently give rise to this phenomenon. 

It is true that a motor nerve may be excited by irritating 
a sensitive nerve, and that the secretion of a gland and the 
nutrition of textures are excited by irritating a ganglion or 
a branch of the sympathetic nerve. Perhaps the phenomena 
of fever are produced by alternately exciting and exhaust- 
ing the influence of the ganglionic system of nerves. The 
altered quality of the blood, and perhaps the direct influence 
of the materies morbi which it contains, irritates this system 
of nerves, and thereby diminishes the heat which answers 
to the chill or rigor, and under the continued irritation and 
excitement this influence is exhausted, and thus heat is 
generated, which answers to the stage of fever. 

The exanthem or eruption is a specific inflammation pro- 
duced by the specific animal poison in the blood. These 
toxaemic diseases clearly exemplify what has been termed 



114 GENERAL PATHOLOGY. 

the vis medicatrix naturse, which is but the limited capability 
of the system to resist or throw off disease. The presence of 
any noxious matters in the blood excites the functional 
activity of the secreting organs, that is, of the entire glandu- 
lar system, which properly includes the skin as well as the 
kidneys. 

If the foreign matter in the circulating fluid is either one 
of the specific animal poisons from which these eruptive 
fevers arise, it multiplies by germ-growth or fermenta- 
tion; but whatever is the nature of the materies morbi, it is 
in itself entirely passive as to special localization. As a 
foreign substance in a bronchial tube, or in the womb, 
excites expulsive efforts, so every secreting organ is excited 
by the presence in the blood of any foreign substance, and 
each appears to strive with increased energy to cast the 
intruder out of the system. 

.Thus it is true of the zymotic poisons from which these 
eruptive fevers arise, that their very effects upon the blood 
and upon the glands and their secretory functions engender 
a process for their elimination from the system. Hence we 
observe that in most of these affections, and especially in 
small-pox and measles, the presence of the poison being' 
intolerable to the system, is cast to the surface more rapidly 
than it can be excreted by the skin, and thus the eruptions 
have their origin. But the poison does not here await its 
turn ; its presence as a foreign substance, and especially as 
a specific virus, irritates the skin, and excites a vast multi- 
plicity of local congestions or inflammations of that organ, 
and these assume the character of numerous circumscribed 
eruptions or pustules. Now these numerous eruptions 
furnish the virus with so many avenues for its escape from 
the system ; for each eruption, whether in the form of a rash 
or a pustule, emits a portion of the materies morbi. There- 
fore, the more numerous the eruptions, the more rapidly 
will the poison be expelled from the system. The amount 
of eruption in any given case is determined by the quantity 



ERUPTIVE FEVERS. 115 

and the degree of virulence of the poison which the system 
has imbibed, and by the degree of resistance the organism 
is capable of opposing to its invasion. 

The poison of these eruptive fevers generally invades 
debilitated systems with great energy, for in such there is 
little capability of resistance to its ravages ; so that the 
poison remains in the blood polluting more and more the 
fountain of life, and, instead of being driven to the surface, 
where it could find a ready exit from the system, it is thrown 
upon the more delicate textures within, and especially upon 
the mucous membranes, where it produces its characteristic 
eruptions. These cases, without enlightened and judicious 
interference, tend certainly and rapidly to death. 

When the system is invaded with energy on account of 
the quantity and virulence of the poison, the resistance 
opposed to it by the secretory system may be considerable, 
and the processes of elimination and depuration may be 
carried on with an energy corresponding with that of the 
invasion. Thus the conflict becomes long and doubtful, 
and while the resistance is sufficient to drive much of the 
poison to the surface, as evinced by numerous eruptions on 
the skin, the force of the poison is sufficient to hold a dis- 
puted position in the blood, and to accumulate in, and give 
rise to, specific inflammation of the mucous membranes, 
which are but the internal reflections of the integument 
of the body. As the external skin forms the covering, the 
internal skin or mucous membrane forms the lining of 
the body and its open cavities, and is, therefore, in point of 
delicacy, as a plant which has grown in the shade. For 
these reasons the eruptions appear inversely on the skin and 
mucous membranes. 

These considerations explain the reasons why the mucous 
membranes generally suffer lesion in these zymotic fevers ; 
and these specific lesions account for those ever-present con- 
comitants which add so much to the sufferings and the 
danger. I allude to the tonsilitis, bronchitis, nephritis and 



116 GENERAL PATHOLOGY. 

the enteritis so often produced by the specific poison from 
which these fevers arise. 

Either one or all of these specific itises may arise in either 
variety of this class of essential fever. But we usually find 
the most severe angina with sloughing of the tonsils, and 
mucous membranes about the fauces and pharynx in scar- 
latina and variola. The Shneiderian membrane, bronchial 
tubes, and the intestinal follicles, all suffer in measles. 
The kidneys and ureters often suffer seriously as a sequel 
to scarlatina. In glanders, the Shneiderian membrane and 
all the air passages, and ultimately the soft tissues, generally 
are effected. In typhoid fever the poison usually affects the 
follicles of the velum palati, and small intestines. These 
various lesions demonstrate the specific character, the 
activity, and the peculiarities of the respective zymotic 
poisons which give rise to the several species of eruptive 
fever. 

General Principles of Treatment. — There is no known 
specific antidote to which either of the respective poisons 
from which these fevers arise is amenable ; but the preced- 
ing facts, connected with their pathology, indicate many 
therapeutic measures well calculated to shorten their dura- 
tion, diminish their severity, and conduct them to a favorable 
termination. 

In the treatment of these fevers, friendly results are most 
readily and certainly secured by the observance of these 
obvious indications: 1. To foster the powers of the system, 
and, as far as possible, guard against internal local lesions. 
2. To promote the early appearance of abundant eruptions 
on the skin ; these, when of the phlegm atous variety, tend 
to exhaust the poison, both by affording it a channel of 
rapid exit from the system, and by increasing the process of 
oxydation. 3. To secure and maintain the free excretion of 
noxious matters from the system by promoting the functional 
activity of all the secretive organs, and especially of the skin 
and kidneys. 



REMEDIAL MEASURES. 117 

The bowels are to be encouraged, when necessary, to one 
or two soluble dejections daily to remove all irritating 
excrements, and thus prevent local irritation and general 
contamination produced by their continued contact with the 
delicate texture of the intestines, and by their reabsorption 
into the blood. But excessive alvine evacuations should be 
carefully avoided, as tending to rapidly exhaust the powers 
of the system, at a time, too, when the energies should be 
fostered to resist the encroachments of the poison. It is an 
anamoly, but is no less a truth, that the diarrhoea which 
comes on during the convalesence from measles is a 
salutary process, and should therefore be tolerated or even 
encouraged within due bounds. 

Diaphoretics and diuretics are of signal service in promo- 
ting the secretions of the skin and kidneys. Tonics and 
antiseptics are urgently indicated, of which the tr. of the 
chloride of iron is most eligible, as possessing both of these 
properties in the highest degree. Sulphur is a good germi- 
cide. 

After the first stage of excitement has passed, quinine is 
useful on account of its tonic and febrifuge properties. Mild 
but nourishing food, when it is not loathed, is essentially 
proper in each of the various grades and stages. Alcoholic 
and other stimulants are indicated in the incipiency of an 
attack, to drive the eruption to the surface, and also in the 
stage of desquamation, to maintain the nagging powers of 
the system. 

The usual inflammatory and other complications are to be 
treated according to such circumstances as their location and 
degree of severity may present. The inflammation about 
the throat is most effectually allayed by astringent, acid and 
chlorinated gargles, and by counter-irritants applied ex- 
ternally. These anginose complications are often much 
relieved by the application of emollient cataplasms over the 
region of the throat. 

When the inflammatory complication is seated in the 



118 GENERAL PATHOLOGY. 

tubes or parenchymatous structure of the lungs, an expec- 
torant is demanded, for which I usually prefer ipecacuanha, 
honey, and tr. opii, in water. Here, too, counter-irritation 
may be of much service. When the lesion is in the follicles 
of the intestines, or any other portion of the primse vise, oil 
terebinth is often highly useful, especially when there is 
hemorrhage or effusion of blood from the bowels. The 
denuded surfaces may be blandly sheathed by mucilaginous 
drinks, such as elm-water, or the mucilage of gum acacia. 

It is an important fact which every practitioner should 
observe, that mercury is especially damaging to a system 
which is infected with either of these or any other zymotic 
poison, and it is not admissible in the treatment of these 
eruptive fevers, except perchance it may be urgently 
demanded to meet some hepatic complication. 

Prophylactic measures display their greatest efficiency 
against these zymotic diseases. The protective power of 
belladonna against scarlatina has long been a moot point. 
Such preventive properties have been repeatedly asserted of 
this drug by eminent authorities, but all experiment has 
furnished but little positive testimony in vindication of the 
assertion. But its action appears to be sufficiently favorable 
to warrant its use, as scarlatina is usually the most active in 
its invasions, and often the most fatal, of all the eruptive 
fevers. Some of these eruptive fevers, as Rubeola, Scarla- 
tina and Variola, affect the same system but once during 
life ; so that the entrance of either of these poisons into the 
system is a pretty reliable prophylactic against future attacks 
or invasions from such poison. The prophylactic property 
of vaccine virus against small-pox has well nigh shorn that 
dire affection of its fatality and its terrors. The discovery 
of this valuable property of the vaccine by Dr. Jenner, of 
England, is but one of the countless blessings which the 
researches of medical science have bestowed on humanity. 

Ectrotic or Abortive Treatment of Variola. — It is a triumphal 
boon to science and to humanity that small-pox may be 



NON-ERUPTIVE FEVERS. 119 

evaded, or rendered benign, as above noticed. Besides, 
when it attacks those who are so protected, it may be much 
ameliorated and rendered abortive, or comparatively power- 
less for evil, by such topical applications as either cauterize 
or form adherent scab-like incrustations over the pustules. 
Either of these measures will arrest the development of the 
pustules, diminish the suffering, and protect the sufferer 
against the disfiguration usually produced by deep pitting 
or unsightly cicatrices. 

The pustules may be cauterized by picking them with a 
needle which has just been inserted into a strong solution 
of argent, nitras, or by touching them with a fused stick 
or the solid crystal of this substance. A coherent and 
efficient crust may be formed upon each pustule by apply- 
ing a plaster formed by saturating the sulphate or the 
carbonate of zinc with olive oil. Drink lemon juice and 
elm-water. 

Non-ervptive Fevers. — The exanthematous fevers which we 
have been considering may truly be said to present various 
kinds, since each of these fevers depends upon a distinct 
specific virus, and is peculiar to itself ; but not so of all the 
grades presented by the paroxysmal and continued fevers, 
which classes are both included under the denomination 
"non-eruptive fevers," of which we now design to treat. 
However, we would exclude from the range and force of this 
remark typhoid, which is sometimes eruptive, often produced 
by a specific cause; and, being a malignant form of con- 
tinued fever, it is capable of being propagated by fomites, 
and doubtless as well by inoculation. But it should not be 
inferred that typhoid can originate in no other way. This, 
as well as all the grades and types of paroxysmal fever, is 
liable to be produced by a great diversity of common causes. 
Besides, it is liable to present itself during the course of 
every continued fever, however mild the attack may appear 
to be; for this fever occurs, in all seasons, and attacks 
systems under numerous and diverse circumstances, and 



120 GENERAL PATHOLOGY. 

thus it is that it assumes various grades, clivers forms and 
dissimilar phases. 

These considerations point to the pathologist as the only 
just arbiter of the states of the system in, and of the mysteries 
which envelop the phenomena of these important forms of 
disease. These investigations elicit the hidden truths of the 
abstruse science of medicine as connected with the various 
states of the system covered or designated by the common 
appellation u essential fever," or even by the term "continued 
fever." Such truths stand as far beyond the comprehension 
of the unlearned, and the ken of "snobs," as do the phe- 
nomena, with which they are associated, beyond the pre- 
tended ameliorating influence of vaunted panaceas and 
quack nostrums. 

Paroxysmal Fevers. — For convenience, and in observance 
of their distinctive peculiarities of type and etiological rela- 
tions, I shall consider the remaining forms of fever in two 
classes, namely : paroxysmal and continued. But it should 
be remembered that the types of these fevers change with 
great facility, so that an intermittent readily passes into a 
remittent, and this by an easy transition as readily becomes 
a continued type. Paroxysmal fever manifests its most 
marked tendency to pass into a continued type about the 
time of the decline of its greatest prevalence, which is late 
in the fall season. 

The causes of these paroxysmal, marsh malarial, or autum- 
nal forms of fever, may be pretty readily and satisfactorily 
explained. The humid atmosphere arising from marshes, 
and charged with noxious gases arising from the decompo- 
sition of organic matter, may be, and doubtless is, a sufficient 
cause. Especially is this cause active when conjoined with 
heat, evaporation, and other solar influences, as is well 
demonstrated by the great prevalence and endemic character 
of these affections among the inhabitants of marsh-lands, 
particularly toward the decline of long hot seasons. 

Heat, when conjoined with a full carbonaceous diet, may 



PAROXYSMAL FEVERS. 121 

produce paroxysmal fever by rarefying the atmosphere, 
which diminishes the quantity of oxygen inhaled, and thus 
interferes with the process of oxygenation of combustive 
materials in the blood, so that the hydro-carbons are per- 
mitted to accumulate in the system faster than they can be 
eliminated by the liver and lungs ; hence, the liver is over- 
worked, and the blood becomes contaminated. 

All debilitating influences tend to produce the par- 
oxysmal and periodic affections. Hence, convalescents 
from the more intense grades of fever, and persons 
who have suffered exhaustive drains from the system, 
or from diarrhoea or hemorrhage, are very liable to 
these attacks. Allied to these types of fever, arising 
from the same causes and amenable to similar treatment, 
are various periodic recurrences of opthalmia, diarrhoea and 
neuralgia. 

The varieties or different types and grades of fever belong- 
ing to this class are : ague or intermittent, bilious or remit- 
tent, and yellow fever, Ague may be quotidian, tertian or 
quartan, according to the type which marks its periodicity, 
or the length of the interval between paroxysms. Each of 
these types of ague is distinguished from bilious fever by 
a period of complete intermission of the fever occurring 
between the termination of each exacerbation and the com- 
mencement of the next. 

Bilious or remittent fever is marked by a continuation of 
the fever, of which there is a decided remission or abatement 
occurring at regular intervals. The remissions usually 
occur every morning, and the fever rises as the day advances, 
and the exacerbations are often attended by much arterial 
excitement and gastric distress, which are well calculated to 
excite alarm in the mind of the novice in practice ; but the 
real danger is not considerable, except from cerebral or other 
rare complications. Under appropriate treatment the fever 
is usually of but a few days' duration, and the prognosis is 
almost universally favorable. 
9 



122 GENERAL PATHOLOGY. 

Yellow Fever. — This species of fever is of the paroxysmal 
genus. It arises from the same causes as remittent, but 
requires a much greater intensity of their action. It is, 
therefore, confined to high temperatures and hot climates, 
as the West Indies and some of the southern cities of the 
United States. Yellow fever may arise sporadically, and it 
may be propagated by contagion. There can be no doubt 
of the contagious character of its most malignant grades. 
Indeed, all malignant diseases are contagious — the} r are 
communicable from one person to another in some way. 
This fever may occur in a very mild character, but it is 
usually malignant and fatal in its tendencies. Its symptoms 
are those of bilious fever intensified to a degree correspond- 
ing with the greater force and intensity of the causes. The 
attack is generally sudden. The pyrexia, heralded by but 
few premonitory symptoms, is often so powerful that the 
secretions are almost entirely suppressed at the outset. 
There is severe pain in the head (usually frontal), back, 
legs and epigastrium. There is extreme irritability of the 
stomach, frequent vomitive efforts, and often vomiting of 
a colorless tenacious matter, followed finally by a dark, 
grumous matter ; hence, the name "black vomit.'" There is 
usually much hepatic derangement, with cholemia, and often 
profound stupor; hence, in terms scarcely so arbitral as 
yellow fever, the affection has been called "typhus iderodes" 
which words are derived from the Greek, and imply stupor 
and yellowness like the eyes of a weasel. 

These paroxysmal fevers all invade the system through 
the blood ; they all manifest a congestive tendency, and are 
all characterized by a well-marked periodicity. It is further 
true of them, in a general sense, that their tendencies to 
malignancy and to periodicity are in inverse ratio. Hence, 
in the mild grade known as ague there is complete and often 
long-continued intermission. In the yet mild but more 
severe form known as bilious fever, there is only a remission 
which is at most of but a few hours' duration ; while in the 



REMEDIAL MEASURES. 123 

malignant grade known as yellow fever, the remission is 
very transient and scarcely perceptible. 

True to the inferences derived from etiological deductions 
the liver suffers in these affections, cseteris paribus, more 
than any other organ. It is either in a state of torpor from 
over-work or excessive functional activity, or it suffers 
perceptible lesion of its structure, which is often revealed by 
the unerring post mortem. Fatty degenerations of this organ 
in persons who have died of yellow fever ; and hepatic abscess 
in those who had suffered long from such chronic affections 
as ague, dyspepsia and dysentery, have been so frequently 
observed that it is a subject of wonder that all pathologists, 
and medical men generally, have not taken the hint. 

The liver is not a "scape goat," nor does it enjoy immunity 
from the encroachments of disease. The many extreme 
and absurd ideas which have prevailed respecting the 
physiological functions and anatomical lesions of this organ 
have led to many errors in practice. 

The spleen is a kind of reservoir, and is the receptacle of 
an increased amount of blood during each successive chill 
or cold stage which precedes each febrile exacerbation. In 
consequence of these repeated congestions this organ becomes 
enlarged, and retains in the ramifications of its capacious 
vessels an augmented onus of blood. Other lesions some- 
times found in the subjects of paroxysmal fever are such as 
may occur in any of the essential fevers. 

Treatment of Paroxysmal Fever. — The milder grades of 
paroxysmal fever, as ague and bilious fever, are remarkably 
amenable to treatment; but its most grave forms, such as 
are known as congestive chill and yellow fever, are often 
fraught with fatality, and sometimes terminate in death 
before aid can be summoned. Each of these forms, however, 
may be comparatively mild. Who can distinguish a differ- 
ence between a severe ague chill and a mild congestive chill? 
or between a severe grade of bilious fever and a mild grade 
of yellow fever? I presume no physician will attempt to 



124 GENERAL PATHOLOGY. 

make these discriminations, seeing they are without differ- 
ences ; and certainly if a difference exists in either case, it 
is in degree only. Then it follows that the same general 
principles of treatment apply alike to all, and that the same 
therapeutic agents that are curative in one are, in some 
degree, efficacious in all. This is eminently true of chola- 
gogues, sudoriflcs, tonics and nervines. 

The measures here suggested are to be varied to meet the 
indications presented by the various grades and complica- 
tions of individual cases. Thus the ordinary forms of ague 
and of bilious fever will generally yield to a purgative, con- 
sisting of the mild chlor. hydrarg. 3 to 5 grs., with 10 to 15 
grs. rhei., followed by 36 grs. of the sulph. quinine, in 6 gr. 
doses taken two or three hours apart during the intermission 
or the remission. More severe cases of bilious fever will 
require the use of the quinine to be continued in this man- 
ner till the fever is arrested, which seldom requires longer 
than three to five days' timely and appropriate treatment. 
During the febrile exacerbations nitre may be administered, 
and cold water should be poured lavishly on the head; but 
this should be withheld when the patient is sweating freely ; 
also, when it ceases to be comfortable to the sufferer. Food 
of all kinds is loathed till the disease begins to subside ; but 
when the appetite returns, it should be gratified with a 
reasonable amount of mild and well-cooked nourishment. 

Yellow Fever requires, in the beginning, a mercurial 
cathartic to clear the bowels of morbid secretions and 
accumulations of fecal matter, and to aid the liver in the 
performance of its functions. This should be followed by 
large and frequently repeated doses of quinine — say .1 grs. 
every two or three hours. Opiates should be administered 
when required to produce sleep and allay morbid vigilance. 
Gastric irritability may be allayed by effervescing draughts, 
and by the application of sinapisms, or fly plasters, to the 
epigastrium. A piece of linen w T et in cold water, and 
applied to the throat, very often arrests vomiting. It is 



CONTINUED FEVER. 125 

very important that the kidneys be aided in the performance 
of their secretory functions by diuretics, of which turpentine 
is the most eligible. 

The prognosis is pretty favorable as long as the renal 
secretion is actively maintained ; and if, in addition to this, 
at the seventh day, there is not copious vomiting of black 
matter, recovery is almost certain. 

Congestive Chill demands stimulants internally, and 
counter-irritants diligently applied externally during the 
stage of congestion, and in the interval quinine should be 
administered in large doses. 

Ague often becomes chronic, in which stage it sometimes 
refuses to yield to the ordinary remedial measures, unless 
they are persisted in till their use becomes as chronic as the 
disease. The tincture of iodine administered in a dose of 
gtts. viij. in an ounce of dulcified water, twice a day, to 
adults, has often speedily eradicated the affection. This use 
of the drug was suggested by the presence of a strumous 
diathesis in many of these cases. 

Emetics often produce the most prompt and satisfactory 
effects in all of these paroxysmal fevers. They cleanse the 
stomach, promote hepatic action, and often cut short the 
fever. When emesis is desired for this purpose, it should 
be produced by ipecacuanha. Antimony and lobelia should 
rather be used to nauseate monks than to collapse people. 
The "root and herb doctors," who have in every way a 
strong tendency to produce vomiting, have occasionally 
arrested an ague with their lobelia. 

Continued Fever. — Essential fever presents a variety yet 
to be considered, having several grades of a continued t}^pe. 
The name "continued fever" applies alike to each of these 
grades, but nosologists have arranged them into classes, and 
found for them names as so many diseases, or independent 
and distinct kinds of fever. Thus the four following groups 
of symptoms, which mark as many stages and grades of 
continued fever, are, according to Drs. Jenner, Tanner, and 



126 GENERAL PATHOLOGY. 

others, named and treated as so many kinds of fever or 
distinct diseases, distinguished from each other by well- 
marked specific differences. Believing such distinctions to 
be unreal and absurd, I conveniently employ these groups 
of symptoms, and bastard names, merely to designate the 
several stages and grades of continued fever : 

Febricula, which is mild and non-contagious as such, is 
sudden in h)s attack and short in its duration, and is 
attended by arterial excitement, headache, backache, white 
tongue and frequent pulse. 

Relapsing fever — a form of fever often engendered by 
specific influences. It may prevail as a contagion or as an 
epidemic, and is medium in grade between febricula and 
typhus. It is attended by the usual febrile symptoms, such 
as rigors, alternated with the flush of fever, headache, con- 
stipation, hepatic derangement, etc. When the fever has 
continued about seven days, profuse perspiration usually 
comes on, and there is a sudden abatement of all the 
symptoms, and convalescence appears to be permanently 
established ; but at the next septenary period there is a 
return of all the primary symptoms, which after remaining 
a few days again subside, and the return to health is rapid. 

Typhus is a more continuous and grave form of fever, and, 
in addition to the initiatory symptoms just mentioned, there 
are stupor, a dry brown tongue, delirium, and often a mul- 
berry rash, which makes its appearance on the body between 
the fifth and eighth day. The fever is obstinate, and gener- 
ally does not terminate before the twenty-first day. The 
lesions usually found after death are enlargement of the 
spleen, and congestion of the various organs, or parts, enclosed 
in the ventral cavity, and especially of mucous surfaces. 

Typhoid, like typhus, arises from the same specific cause, 
is contagious, is attended by stupor, rash and extreme 
debility, and is even more persistent and fatal in its tenden- 
cies. Diarrhoea is usually present from the beginning, or is 
one of the earliest evidences of the approach to typhoid. In 



SYMPTOMS AND SIGNS. 127 

all low grades of continued fever the bowels are apt to move 
readily and freely under the influence of half the ordinary 
dose of any cathartic medicine, and even the higher grades 
will readily run into typhoid if excessive purgation is pro- 
duced or permitted. The bowels are usually tender to 
pressure in the region of the right iliac fossa. The tongue 
becomes dry and cracked, and the lips and teeth are often 
covered with a black secretion called sordes. The surface is 
generally cool and often moist, especially after the fifteenth 
day. The circulation is accelerated, and generally the fre- 
quency of the pulse is in direct ratio to the severity of the case. 

The lesions found after death are enlargment and soften- 
ing of the spleen, which often contains numerous singular 
bodies, which, according to Dr. Bennett, consists of splenic 
pulp in a state of peculiar degeneration, and yellow discolo- 
ration ; but, according to Eokitanski, they consist of a true 
typhus deposit. The mesenteric and intestinal glands are 
generally congested, and often there is ulceration of Peyer's 
patches. 

Such are the symptoms and lesions common to four 
different stages and grades of continued fever ; I therefore 
demur to the doctrine that these several grades are as many 
distinct diseases, for the following satisfactory reasons : 

First. The aggregate of the symptoms and lesions noticed 
by Jenner (in his very able monograph on fevers) as pathog- 
nomonic respectively of Febricula, Relapsing Fever, Typhus 
and T}^phoid Fever, may all be present at the same or at 
different times during the course of a severe and persistent 
fever ; hence a fever may set in as a synocha, degrade into 
a synochus, and finally terminate in typhoid. 

Second. The poison of continued fever may be communi- 
cated from one person to another by contagion ; it may arise 
sporadically, or it may be generated in the system by the 
accumulation in the blood of a superabundance of waste 
material derived from tissue metamorphosis and retained in 
the system in consequence of the tardy secretory action com- 



128 GENERAL PATHOLOGY. 

mon to all febrile affections, Thus it is, that a fever having no 
specific cause often assumes a specific character, becomes con- 
tagious, and presents the most grave symptoms and lesions- 

Third. The various symptom which Dr. Jenner pointed 
out as peculiarly characteristic of certain hinds of continued 
fever, are not necessarily produced by as many distinct 
prime specific agencies, but are generally consequent upon 
and indicative only of the stage and grade of the fever. All 
protracted fevers in their advanced stages present similar 
lesions and symptoms, and such generally as indicate a low 
grade. 

Continued fever arises from a great diversity of causes, 
prevails in all seasons, and attacks persons of all ages, habits 
of life, and constitutional peculiarities. Besides, its grade 
and character are peculiarly influenced by the character of 
contagious and epidemic influences prevailing at different 
times ; so that it would be a singular anomaly if it did not 
present the various phenomena and phases which have been 
erroneously considered as so many distinct diseases. 

The causes of continued fever embrace all influences and 
agencies capable of deteriorating the blood and debilitating 
the system. Among the most frequent causes may be 
mentioned a specific animal virus which may be communi- 
cated from one person to another — non-cognizable agencies, 
or epidemic influences, which are supposed to originate 
spontaneously and to exist temporarily in the atmosphere of 
any locality — insufficient and improper nourishment — heat 
or cold long continued, especialty when conjoined with 
dampness — dark and ill-ventilated apartments — filth, and 
the effluvia arising from putrescent animal bodies. 

Symptoms. — The symptoms common to its various stages 
and grades have been mentioned respectively under the 
several heads — Febricula, Relapsing Fever, Typhus and 
Typhoid. 

Diagnosis. — When a fever begins with a frequent, full and 
bounding pulse, and continues to run high without remis- 



DIAGNOSIS. 129 

sion for forty-eight or seventy-two hours, it is not likely to 
be an idiopathic fever at all, but is symptomatic of inflam- 
mation in some of the textures of the system. If the fever 
is characterized by well-marked intermissions or remissions, 
and especially if these occur of mornings, the fever is 
idiopathic, but it belongs to the paroxysmal, and not to the 
continued type of fever. But when the fever comes on after 
a few days or weeks of malaise, and continues steadily from 
day to day, with an irregular distribution of heat, it is most 
probably the common continued fever. The presence of 
slight remissions should not militate against this diagnosis, 
as these are common to continued fever in all its grades, but 
are less perceptible as the form of the fever is more grave. 
If there is diarrhoea, listlessness and stupor, the diagnosis 
is strengthened. Ulceration of Peyer's glands, as indicated 
by diarrhoea and tenderness to pressure in the right iliac 
region, have been held as pathognomonic of typhoid fever. 
But these phenomena, though strongly corroborative, do not 
always prove that typhoid is present, neither does their 
absence prove that typhoid is not present. 

Much has been said and written respecting the differential 
diagnosis between typhus and typhoid fever, which have been 
supposed to be two distinct kinds of continued fever. This 
reminds us of the absurdities of the darker ages. We have 
all read of the three kinds of scarlet fever — the simplex, 
anginosa and maligna, according to the grade and local tend- 
ency of the affection. And we have heard of the two kinds 
of measles — the big red, and the little French kinds — which 
are the results of circumstances which promote or retard the 
eruption ; of course, the big red kind was the milder. Xow 
we hear of the two kinds of continued fever — typhoid and 
typhus. Here again the distinction is founded on the grades 
and phases of the fever. If the quantity and virulence of 
the poison are sufficient to irritate the mesenteric and intes- 
tinal glands (which appear to excrete it), and produce 
diarrhoea, and to break down the red corpuscles, and retard 



130 GENERAL PATHOLOGY. 

the motion of the blood through the capillaries, and thus 
give rise to small red spots on the surface, the fever is said 
to be the typhoid kind ; but if the poison acts with less 
intensity, so that there is less prostration, less intestinal 
irritation and its consequences, such as tenderness, diarrhoea 
and hemorrhage, then the fever is called typhus. Now these 
unwarrantable distinctions make a trio of parallel absurdities 
which are reproachful to a learned medical profession. It is 
even strange that such doctrines can be imposed on popular 
credulity. 

Prognosis. — It is generally difficult, and often impossible, 
to tell in the beginning of a continued fever what grade it 
will assume, or when it will terminate. If there is no con- 
siderable prostration, and the pulse is regular and but little 
above the normal standard, the attack is usually mild, and 
may pass off in a few days as a febricula, or about the 
seventh day as a relapsing fever. Or it may go on till the end 
of the second, third or fourth septenary period, the grade 
usually becoming lower as the disease continues till it assumes 
the lowest grade of continued fever, known as typhoid. 

On the other hand, if the fever begins with a frequent 
pulse ranging from 120 to 140 beats per minute, with diar- 
rhoea and prostration, and especially if delirium is present, 
the attack is most grave, and the condition of the patient is 
precarious. In such cases as this, the fever does not pass 
through the higher grades known as febricula, relapsing 
fever and typhus, but is a genuine typhoid from the begin- 
ning. The attacks are more common, and the disease is 
more malignant and contagious when it is intensified by 
epidemic influences. 

In the early stage unusual talkativeness of the patient, 
and the hallucination that he or she is not sick, and should 
be up and attending to business, are decidedly unfavorable 
symptoms. Hemorrhage from the bowels, acuteness of hear- 
ing, evacuating the bowels, or voiding the urine uncon- 
sciously, and muscse volitantes, or catching at imaginary 



REMEDIAL MEASURES. 131 

objects, each augurs unfavorably ; but there may, in a rare 
instance, be a recovery when each of these symptoms have 
at different times been present. But all together, they 
warrant the most unfavorable prognosis of all phenomena 
this side of the awful hour of psychorages. Add to all, or a 
part of the above symptoms, a nagging pulse, and slow and 
labored respiration, with elevation of the shoulders at each 
inspiration, and the sufferer is moribund. 

On the other hand the favorable symptoms are a regular 
pulse tending to the normal standard in frequency ; the 
urine less colored, the tongue becomes moist, and begins to 
shed its coat; the sordes begin to disappear from the 
teeth, tongue and lips; the appetite begins to return; 
delirium gives way to recuperative reason; coma is dis- 
pelled by natural and refreshing sleep. The patient now 
complains of being uncomfortable in the dorsal decubitus 
previously preferred, and begins to draw up the legs, and 
to express a desire to change from the dorsal to the lateral 
decubitus ; the strength increases, and the return to health 
is slow but pretty certain. 

Treatment of Continued Fever. — In this as in other diseases, 
the treatment should be varied according to its various 
stages, grades and complications. In some of its forms it 
requires but little medicine, and in no case does it require 
so much debilitating medicine as is too frequently adminis- 
tered. It is to this error in practice that most of the fatality 
of fever is due. Mild attacks in which there is no diarrhoea 
require about half of an ordinary dose of some mild purgative 
in the beginning to clear the bowels. A drachm of the 
syrup rhei is very eligible, and this should be made the 
vehicle for two or three grains of the mild chlor. hydrarg. if 
there is much hepatic derangement. Afterwards care should 
be taken to prevent the bowels from moving too freely, and 
no circumstance is likely to warrant the further use of 
mercury. This should be followed by oil terebinth, gtt. x., 
bis in dies ; sulph. quinine, grs. iv., tert horis vel ter dies ; and 



132 GENERAL PATHOLOGY. 

opii, gr. j., hora decubitus; warm bath. I have often seen the 
fever cut short by these means timely administered. But 
if the fever continues, let this treatment continue as long, 
omitting the mercury and the purgative, except in rare 
instances. 

The bowels should, if possible be confined to one evacu- 
ation every twenty-four hours ; if they are at any time to be 
encouraged to this, a light dose of ol. ricinis will suffice. If, 
as is most usual, the bowels require restraint, a few grains 
of tannin after each operation will often suffice ; but the most 
effectual dose for this purpose consists of pulv. opii, gr. ss., 
and acetas plumbi, grs. iij. As an alternate, with either of 
the measures mentioned for checking the bowels, I have 
often been pleased with the effect of a mixture consisting of 
tr. opii, tr. camphor, and tr. rhei, in equal parts, and capsi- 
cum in the proportion of 10 grs. to the ounce ; dose, one 
drachm, repeated every hour, or oftenerif necessary. I have 
thus dwelt upon the means of holding the bowels, because it 
is a sine qua non in the treatment of the lower grades of 
continued fever. 

Complications, when they arise, must be treated on gen- 
eral principles ; but no inflammation, however important the 
organ involved, will justify the free use of antiphlogistics. 
Local hyperemia may be relieved by counter-irritants in the 
form of sinapisms, or a fly-plaster. Headache and often 
delirium, may be relieved by the application of cold to the 
head by means of ice-bags kept in contact with the head, or 
the frequent pouring on of cold water. But these means 
should not be resorted to while the patient is sweating freely ; 
or if they produce chilliness or other unpleasant sensations 
at any time, they should be temporarily withheld. A fly- 
blister at the back of the neck is often of signal service in 
relieving the brain, and obviating delirium and coma. 

Hemorrhage from the bowels seldom occurs in cases 
treated from the beginning with turpentine ; but when it does 
occur, the terebinth should be doubled, and tr. chlor. ferri 



REMEDIAL MEASURES. 133 

administered in half-drachm doses every six hours, and the 
bowels should be locked with opium for two days. I have 
often known the hemorrhage arrested and recovery to ensue 
after two quarts of dark and offensive clotted blood had 
been discharged from the bowels. 

Alcoholic stimulants should be administered in small 
quantities every two hours, and as much oftener as may be 
necessary, to obviate extreme prostration, and to keep up an 
equable circulation. Thousands have sunk to premature 
graves under the prostration attendant upon continued fever 
when they might have recovered by the free use of brandy. 

The patient's entire surface should be washed by sponging 
with tepid salt water every second day, and the apparel 
changed as often. In fine summer weather the room should 
be so ventilated that the patient can breathe freely from the 
great ocean of pure atmospheric air. The feet should be 
kept warm at all times. Visitors should not crowd the room ; 
quietude is at all times desirable, and especial] y at night. 
The patient should drink moderately of elm water and ice 
water ; but the latter should be withheld when it moves the 
bowels, as it sometimes does. 

Food, when not loathed, should be taken often, but in 
small quantities, and while it is cool, and should consist of 
milk, panada and animal broths. 



134 GENERAL PATHOLOGY 



CHAPTER X. 

TETANUS — GANGRENE, AND SYPHILIS. 

Specialties are not in favor with the author, who is accus- 
tomed to think, write and practise, in the guidance of prin- 
ciples of extensive application, upon which specialties rest. 
From this standpoint it is his present purpose to extend 
some thoughts, briefly and in succession, to Tetanus, 
Gangrene and Syphilis. 

The two last mentioned have some degree of analogy in this, 
that each depends upon animal poison ; ergo, their etiology is 
with the zymoses. Tetanus is not included in this trio, 
because of analogy to the others ; it does not necessarily 
possess any character in common with them. It properly 
belongs to the neuroses ; its pathology has never been defi- 
nitely settled, and it is very obstinate. The muscular con- 
tractions which characterize tetanus depend always I 
believe, upon injury to a nerve ; generally, a small twig at 
the distal extremity of the nerve. It may, but seldom does, 
occur idiopathically ; it almost always occurs traumatically 
in those who are suffering from a wound or injury, and is 
by far the most likely to occur if the wound is very slight 
and is situated on an extremity. It is more liable to be pro- 
duced by a wound on the foot than on the leg, and more 
likely if the wound is on the hand than on the arm. Wounds 
of the feet and hands expose to equal liability to tetanus; a 
very trivial wound of the web between the toes or the fingers 
or under the nail, frequently produces tetanus. The able 
Professor of Pathology in the St. Louis Medical College, in 



TETANUS. 135 

speaking of the causes of tetanus, quaintly remarked that it 
is often caused by sticking a spicule of cornstalk under the 
nail of the great toe. 

The robust and middle-aged are not so liable to tetanus as 
the delicate and the old. The oppressive heat of summer 
predisposes to tetanus, as do hot days alternated with cold 
nights. In our late cival war, and in the Peninsular war, it 
was observed that the wounded men who had to remain 
for many hours without shelter, and without having their 
wounds dressed, were more liable to be attacked with 
tetanus. 

This, like all obstinate forms of disease, has had many 
vaunted remedies ; but one has given place to another till 
almost every drug in the materia medica has been tried. 
But few have proved to be even palliative ; mercury, opium, 
cannabis Indica, and the terebinths, are useless generally. 
The nerve leading to the wound should be divided ; this is 
often effective when done early. Chloroform and sulphuric 
ether, from their potential influence upon the nerve centers, 
ought to control this affection more effectually than any 
known substances. It is remarkably strange that these 
agents, which so promptly control both sensation and reflex 
action, have not been more frequently used against tetanus. 

It is manifest that the sympathy of the spinal cord with 
its nerve branches accounts for the characteristic contrac- 
tions. When the distal extremity of a nerve suffers injury, 
the irritation is carried to the spinal cord, and is renexed 
back by the motor filaments with perverted energy upon 
the voluntary muscles. In the hands of the author, chlo- 
roform has proved to be an effective modifier of these 
unfriendly perversions. A soldier received a flesh-wound, 
near Atlanta, Georgia, by a minnie-ball passing between 
the tendo-Achilles and the bones of the leg. The wound 
gave an unusual degree of pain, which evidently origi- 
nated from injury to the saphenus nerve. On the tenth 
day after the injury, traumatic tetanus appeared in its most 



136 GENERAL PATHOLOGY. 

violent form — every limb was stiff — the hands were clenched 
— the masseters held the inferior maxillary firmly against 
its fellow — the contractions were tonic. Chloroform was 
administered more solito ; soon the contractions were clonic, 
and when he was fully under the influence of the drug every 
muscle relaxed. As the effect of the chloroform passed off, 
clonic contractions appeared ; these were controlled by allow- 
ing him a few inhalations of the vapor at increasing inter- 
vals. Six hours afterwards, every nerve was performing 
its functions well, and the voluntary muscles were at rest. 
The recovery was complete and permanent, though the seat 
of local irritation, or ipse morbus, remained intact. 

Gangrene. — The antidotal influence of bromine upon 
gangrene and other zymotic poisons is most efficient, and is 
perhaps the least known. The use of it in gangrene, in the 
Clay General Hospital, at Louisville, Ky., was attended with 
unvarying success. The solution was made with 1 oz. of 
bromine to 3 ozs. of water. Doubtless the reason iodine has 
failed, in some hands, to accomplish the same results, is 
because the solution was prepared too weak. In August, 
1864, gangrene became rife among the wounded of Sherman's 
army at Marietta, Ga. Having had much to do with this 
fearful malady, I was directed to have all the patients 
affected with gangrene conveyed to an isolated apartment, 
and to direct their treatment, in addition to my duties as 
Surgeon in charge of the officers' department of the 17th 
Army Corps Hospital. A tent was accordingly pitched, in 
which about fifty cases were treated ; of these many appeared 
to be hopeless. 

It would be useless to weary the reader with a tedious 
iteration of special cases, as he is presumed to know that 
gangrene is a stage of mortification ; that it is propagated 
by an infectious and inoculable animal poison, which may 
be introduced into the system through wounds or abrasions ; 
that it declares its presence by local but rapidly progressive 
death of the tissues, and as the blood imbibes the virus it 



GANGRENE SYPHILIS. 137 

tends to necremia. The treatment consisted of fresh air and 
beef tea ad libitum, whisky freely, and morphine as occasion 
required. R. — Tr. chlor. ferri, gtts. 30 ; aqua, oz. 3— ft. mist, 
haust. ter die sumend. To some of them sulph. quin. was 
administered. There was no bromine on hand ; therefore, 
as iodine is nearly allied to it in chemical properties, it was 
used topically as a substitute. E. — Offic. tr. iod., ozs. 6 ; 
iod., grs. 40 ; iod. pot., grs. 20 — ft. mist, bis in dies applic. 

I am satisfied that both iodine and bromine, when applied 
locally, are taken into the blood by the veins and lymphatic 
vessels, and are potential agents against gangrene, erysipelas, 
and other zymotic poisons. That these substances, applied 
topically, act constitutionally by being absorbed into the 
blood, is evinced by the sudden abatement of the constitu- 
tional symptoms that follows their use. They may also 
destroy baccilli. The above is an outline of the treatment ; 
of course, it varies with circumstances, as in all other forms 
of diseases. Of the fifty cases treated, the loss was nil. 

Syphilis. — Since the days of Paracelsus, many theories 
with regard to syphilis have been announced, flourished for 
a time, and vanished. But one idea withstood this meta- 
morphosis, viz. : that mercury is its specific ; and it is of this 
I wish to speak. It is passing strange, that a delusion so 
mischievous could so long escape the lore and acumen of so 
many keen observers. 

Who knows more of syphilis than that it is a specific 
animal poison, and that it contaminates the system through 
the blood ? If it be insisted that it affects the system in a 
specific manner peculiar to itself, I answer so do its ana- 
logues, variola, hydrophobia and scarlatina. 

Liebig picks up the similitude, and views their action as 
catalytic. He shows that the poison is soon destroyed when 
it produces acute fever, as in variola and scarlatina, because 
the anorexia diminishes chymification and the blood-letting 
process. This view is well sustained when we observe 
further that such animal poisons as may exist long in the 
10 



138 GENERAL PATHOLOGY. 

system without disturbing the digestive organs, do contami- 
nate it, and lay the foundation for after troubles. Of such, 
are syphilis, yaws and hydrophobia. Further, we observe 
that in hot climates, where people consume most light 
vegetable food, syphilis is most mild. 

Ricord's doctrine, that there are two venereal contagions, 
is antagonized by Rollett, Diday, and other eminent authori- 
ties. It is very evident that syphilis and gonorrhea are 
distinct venereal poisons. The varied phenomena presented 
by syphilis are sufficiently explained by habits of life, 
temperament, etc. Beyond all doubt its ravages are greater 
in systems that have been saturated with mercury, either 
after or prior to the inception of the virus. Yet these 
ravages are perpetuated, with effects as detrimental to the 
profession as injurious to the health of the patient. But 
there is reason to believe that the enlightened researches 
of progressive science will palsy the prestige of routine, 
and break the spell that pinions the profession to the 
antiquated, but fatal, dogma — "Mercury cures syphilis." 
This is traditional empiricism, not supported, but con- 
demned by all that is known of the pathology of syphilis, 
and thrice condemned by clinical revelation. Specific 
animal poisons give rise to a large community of diseases, 
in each of which mercury is most positively contra-indicated. 
True, much damage was done in the darker ages by treating 
them with mercury ; but what enlightened physician of this 
day would think of treating any of the long list of zymotic 
diseases with mercury? A single dose must sometimes be 
given to meet the urgent indication of some complication ; 
but its use is never demanded, and but seldom justified, 
in any zymotic disease. Syphilis is no more exempt from 
the force of these truths than scarlatina. But the bad 
effects of mercury do not appear so early in syphilis as in 
the latter, because it is more chronic ; the poison ferments 
slower, and does not so soon evince the presence of either 
the animal or mineral poison. It is deplorable that some- 



SYPHILIS. 139 

body once said that mercury is a specific — that it is "good 
for syphilis." 

The persistent routinist continues to torture his patients 
with ptyalism; not neutralizing the virus already in the 
system, but adding another, which alone, or in intensified 
concert with the first, increases the violence and danger of 
after troubles. It is well known that mercury produces 
disease so like syphilis, that it is not easy to make the 
differential diagnosis ; and if the patient appears to, or does, 
recover — as they sometimes will, in spite of the mercury — 
the mercury gets the credit, and the error is perpetuated. 
But if mercuro-syphilitic troubles afterwards come, they are 
thought to be the horrid ravages of syphilis. 

It is amusing to read the spirited debates in Medical 
Societies upon the subject. Some men of profound erudition 
yet advocate the old mercurial treatment for syphilis; — 
others of equal ability and a grade more independence of 
thought, and with the meekness of a Moses and the doubt 
of Diclymus, venture to question the use of mercury in the 
phagedenic or soft chancre, but think it an indispensable 
desideratum in the indurated or Hunterian variety. Druitt 
discovers the delusion, but only advances to do the subject 
quasi justice — like the advocates of ptyalism in other forms 
of disease, who had been impelled to renounce it ; but they 
were still for "touching the gums" — yet this is ptyalism — a pig 
is a hog ! Such is the reluctance and gradual haste with 
which even able medical men adandon old errors to which 
they have become wedded. But they should divorce them- 
selves if they would walk in the light of science — if they 
would successfully combat disease — if they would represent 
the friendly powers of the healing art. 

General Treatment. — The treatment of syphilis is local or 
surgical; also, medical or constitutional. Every chancre 
should be cauterized as soon as it makes its appearance ; so 
also should every sore of doubtful character. The earlier a 
chancre is cauterized, cseteris paribus, the less liable the 



140 GENERAL PATHOLOGY. 

system to constitutional contamination. Cauterization with 
nitric acid is most effective, and should be resorted to before 
the chancre is a day old. Iodoform dressings ; iod. pot. in 
30 gr. doses, three times a day ; mild diet, frequent baths, 
and strict cleanliness. In the secondary and tertiary stages, 
the following : R. — Comp. syr. stilling., 4 ounces ; tr. iod., 
2 drachms. Mix. Sig. 1 drachm ter. dies. 

The strict observance of hygienic measures is highly 
important. A medium temperature should be strictly 
maintained —the dress should be well adapted to the season 
— the bowels well regulated ; constipation and drastic 
purgatives shoud be alike avoided. Frequent bathing is 
of special service ; the baths should be tepid, and saturated 
with chloride of sodium. In the primary stage, rest should 
be enjoined. 

According to Prof. Bennett, more than eighty thousand 
cases of syphilis have been submitted to experiment, which 
establishes beyond all doubt that the mild treatment as 
above directed leads to a quicker and more permanent cure 
than the mercurial treatment. 



SEMEIOLOGY. 141 



CHAPTER XI. 

SEMEIOLOGY AND DIAGNOSIS — PROGNOSIS. 

Semeiology is that branch of pathology which treats of the 
symptoms or signs of disease. Symptoms are derangements 
of the functions of any organ or part of the organism. They 
are the beacon lights which direct our investigations of the 
state of the system, and the signals upon which correct diag- 
noses and rational therapeutics proceed. 

Some discrimination has been made between a symptom 
and a sign of disease. Symptoms are vital signs, and are 
indicative of functional derangement of an organ or part, as 
pain, nausea and spasm. Signs proper are such evidences 
as indicate more definitely to our senses structural change, 
or the physical condition or properties of an organ or part, 
as exemplified by position, bulk, weight, shape, color, etc. 
These evidences are usually elicited by sight, palpation, 
auscultation and percussion. Then, according to this classifi- 
cation, symptoms are subordinate auxiliaries to signs. A 
symptom is often common to various states of the system, 
and is therefore void of any definite signification. But when, 
in any case, the corroborative language of the symptoms 
calls attention directly to the suffering organ, and also 
affords a definite clue to the character of the lesion, they 
have collectively been called a sign. 

An individual suffers with pain in the precordial region 
with epistaxis, or occasional hemorrhage from the lungs, 
and dropsical effusions in the chest and lower extremities. 
These would be mere symptoms to one, while to a more 
skillful observer they would be a sign of obstruction in the 



142 GENERAL PATHOLOGY. 

valves of the heart. An icterode hue of the skin is itself a 
sign of existing hepatic derangement, in consequence of 
which a portion of bile has got into the blood. Skill in inter- 
rogating all the organs of the system, and in eliciting and 
properly appreciating the symptoms which mark their 
changes, is the great sine qua non upon which depends 
accuracy of diagnosis, prognosis and treatment of disease; 
and it is the highest accomplishment a physician can possess, 
and doubtless the most learned eminence that mortal man 
can attain. 

Often a single symptom, or combination of symptoms, 
reveals correctly the diagnosis, prognosis and the indications 
of treatment. This is mainly true of the symptoms presented 
by disease in its advanced stage, as exemplified by typhus, 
phthisis and diabetes. But the physician is often called 
upon to diagnose, prognose and treat, the various forms of 
disease in their incipiency, when they present no definite or 
well developed symptoms, nor indications. Here it is that 
the physician exercises the finest discrimination in con- 
sidering the relative dependence of all the implicated organs, 
and in receiving their conflicting testimony as that of so 
many contradictory witnesses. 

In such cases accuracy can only be attained by faithfully 
investigating all the symptoms, one of which may specially 
aid the diagnosis, another may indicate the prognosis, and 
still another may point to the indications. 

Difficult as the task may be, we should never be content 
with pushing our investigations only so far as to locate the 
lesion in some organ ; but having definitely ascertained the 
location of the lesion, we should strive to determine its 
character, and the stage to which it has advanced, and the 
complications, if any, with which it is associated. Upon 
these latter points especially depend a reliable prognosis, 
and a successful treatment. 

The quack, void alike of learning and conscience, goes 
bravely through the "quiz" of his patients and their inter- 



DIAGNOSIS. 143 

ested but too-confiding friends, upon an erroneous, or, at the 
best, very indefinite diagnosis. Thus, we often hear practition- 
ers who are riding the medical profession to the detriment of 
the character which wise men have given it, remark, with 
much assumed wisdom and gravity of manner, "The patient 
has disease of the heart, disease of the lungs, or disease of the 
womb;" and this is often satisfactory to his unsuspecting- 
patrons ; but if some solicitous friend is thoughtful enough 
to. ask him what kind of a disease, and whereabouts in the 
organ it is situated, he would give it a name, location and 
character to satisfy inquiry till he collects his fee and gets 
out of sight, or, at least, to shield his ignorance till a 
physician comes to expose it. 

Scarcely less reprehensible are those adventurers in the 
practice of medicine, who admit their unpardonable defects, 
and strive to saddle them alike on the worthy members of 
the profession. Thus, they will say, "Doctors don't under- 
stand the diseases of children." "We can't tell what ails a 
child." Now, if they cannot tell what is the matter with a 
child because they can elicit no word of complaint from it, 
why do they visit adults when they are insensible or speech- 
less? It is but justice to medical men to say that they do 
not share such ignorance. It is often difficult to diagnose 
disease in an infant, but it is seldom beyond the ken of the 
physician who is guided by sound reason and the light of 
pathology. 

Correct diagnosis points out the proper indications, and is 
suggestive of proper measures to meet them, in each indi- 
vidual case, and is therefore an indispensable requisite to a 
rational practice. In order to form such diagnosis, the 
physician, when he approaches the bed-side, should be able to 
call into requisition a thorough knowledge of anatomy, phy- 
siology and pathology, and this essential duty is to be 
performed before he administers a single dose of medicine — 
before he knows what indications are presenting, and cer- 
tainly before he knows what medicines or appliances are 



144 GENERAL PATHOLOGY. 

demanded, or from what kingdom of nature they are to be 
derived. Then how fallacious the doctrines and how absurd 
the claims of those who found their low creeds upon the use 
of medicines derived from a certain kingdom of nature, or 
subjected to a process of trituration, with the absurd idea of 
potentializing, while they are almost in total ignorance of 
the structure of the human system, of its various changes 
and conditions, which suggest the varied uses of medicine ; 
and, necessarily, alike ignorant of the physiological action 
and thereapeutic properties both of the medicines which 
they administer and of those which they condemn. 

Examination of the Patient. — The physician should approach 
his patients in an agreeable mood, and manifest to them a 
due degree of sympathy and respect. He should feel free to 
ask all questions necessary to a thorough examination of 
the case, but should by no means intrude upon the patient 
a long series of irrelevant questions, calculated to weary 
their patience, or shock their modesty, for the sole purpose 
of appearing extremely wise. Neither should he sit patiently 
to hear a detailed narration of all the frivolous incidents that 
have occurred during the last ten years of the patient's life. 
The statements of the patient often aid materially in forming 
a diagnosis, but sometimes they are to be taken with a great 
deal of allowance. The questions should be in comprehen- 
sive language, and such as are suggested by the symptoms 
or by previously ascertained facts. I need scarcely remark 
that it is very gross and non-professional for a physician to 
begin the examination of a case by asking the patient what 
is the matter. 

It is well, after addressing the patient pleasantly, to direct 
questions in this manner: "How long have you been sick? 
Are you suffering a great deal? " and so on with such other 
important questions as may present themselves. I am 
accustomed to diagnose by exclusion ; that is by commenc- 
ing at some organ, say at the brain, and examining every 
organ cursorily or minutely as circumstances may require 



SYMPTOMS AND SIGNS OF DISEASE. 145 

and then exclude from special attention such organs as 
are found to be healthy. Proceeding in this manner, 
examinations are most conveniently and satisfactorily 
performed. 

Thus we interrogate the functions of the brain : Is the 
intellect bright, obtuse or annihilated ? These latter phe- 
nomena are inevitable consequences of congestion of that 
organ, and if, in addition to impaired intellect, we find the 
head hot and the extremities cold, the evidences are con- 
clusive. But the intellectual faculties are often deranged by 
foreign poisons circulating in the blood, or in consequence 
of insufficient stimulus imparted by that fluid to the brain, 
as in the low grades of continued fever. Ringing in the ears 
like the jingle of a bell, the rush of wind, or the roar of a 
cataract — tinnitus aurium — is a symptom which sometimes 
arises from very trivial causes, but it often indicates soften- 
ing of the brain or of its meninges. The hearing may be 
obtuse in consequence of the accumulation of cerate in the 
auditory canal, of enlargement of the tonsils, which produces 
occlusion of the eustachian tubes, or of some of the various 
lesions, or influences which render the auditory nerves in- 
capable of receiving the impression produced by the vibra- 
tions of air. On the other hand, the auditory, nerves may 
be remarkably sensitive to these impressions when the hear- 
ing is correspondingly acute. Either obtuseness or acute- 
ness of the function of audition may be present during the 
course of continued fever ; of these, acuteness is always the 
more grave symptom. 

The appearance of the face is often a good index to the 
character of disease. The blanched cheek and the pallid lips 
at least indicate anemia. The corrugated brow indicates 
agonizing pain, which is generally situated in the abdominal 
region. 

The eye, when dull and heavy, indicates languor; when 
the minute branches of veins which ramify the cornea are 
red and distended with blood, it indicates cerebral conges- 



146 GENERAL PATHOLOGY. 

tion, when there is not inflammation of the eye ; when glazed 
and sunken, it indicates approaching dissolution. 

The nose, when it presents a peculiar sharp appearance, 
indicates excruciating pain; when the anterior nares are 
expanded, it indicates difficulty of breathing; when the 
nasal bones are destroyed, so as to let the nose flat down on 
the face, it tells of the ravages of syphilis, especially if there 
is no external cicatrix. 

The mouth, too, is expressive. Thick and pendent lips 
are expressive of nausea, and of dull pain ; when the lips 
appear thin and compressed, it is expressive of lancinating 
pain. 

The tongue reveals many secrets. When covered with a 
thick coat of yellowish or brownish fur, it indicates torpidity 
of the liver ; a similar coat, with red tip and edges, indicates 
inflammation or irritation of the large intestines. As seen 
in dysentery, sordes on the tongue and lips indicates contam- 
ination of the blood, and much debility. A coat of white fur 
on the tongue indicates inflammation of serous or of fibrin- 
ous tissue, as seen in rheumatism and in inflammation of the 
membranes of the brain ; it also often indicates the presence 
of worms in the intestines. 

It should however be remembered, in this connection, that 
it is common for an infant to have a white tongue. A tongue 
covered with a white fur, through which project numerous 
red papillae, is indicative of some of the zymotic fevers, and 
especially of scarlatina and measles. A sharp, red tongue 
indicates inflammation or irritation of mucous membranes. 
A tongue which is dry, parched and fissured, characterizes 
the low grades of fever. 

Dysphagia, or difficulty of swallowing, is a symptom com- 
mon to most of the anginose affections, and especially those 
involving the uvula and tonsils. Dyspnoea, or difficulty ol 
breathing, is indicative of various lesions of the respiratory 
apparatus, as inflammation of the larynx, trachea, or the 
lungs, and it is usually a distressing symptom in asthma, 



DYSPNOEA — COUGH — PULSE. 147 

phthisis, and emphysema. Difficult breathing also attends 
any obstruction of the valves of the left side of the heart, 
capable of retarding the flow of blood from the lungs. This 
symptom also attends when any fluid has collected in the 
pleural cavity. The accumulated fluid which thus encum- 
bers the lungs may be water (kydrothorax), or pus (empyema). 

Cough is produced by any of those conditions just men- 
tioned as giving rise to dyspnoea, also by some morbid states 
of the liver, in which its vicarious relation to the lungs 
is interrupted ; and a very peculiar cough often attends 
hysteria. 

Auscultation and percussion furnish many valuable phy- 
sical signs which materially aid in diagnosing diseases of the 
heart and lungs. Physical exploration of the chest presents 
a vast field for profitable research and practical reform, but 
too much of detail for the design and scope of this work. 

It may suffice to say here that a healthy lung yields a 
resonant sound on percussion. Undue resonance indicates 
emphysema, or pneumothorax. Undue resonance of the 
voice in any region of the chest indicates that the lung con- 
tains a hard mass of tubercles, or is rendered dense by inflam- 
mation, so as to conduct the murmur of the voice from 
the bronchi directly to the ear of the listener ; this sound is 
called bronchophony. Dullness on percussion indicates that 
the air is partially or entirely excluded from the region of 
the lung by a tubercular mass, or by exudation of lymph, as 
in hepatization resulting from inflammation. The crepitant 
rale is heard in the incipient, and again in the declining 
stage of pneumonia. 

The pulse is a most instructive guide to diagnosis, prog- 
nosis, and the indications of treatment. An irregular pulse 
shows a want of balance in the circulation, and with other 
corroborative symptoms it is symptomatic of organic lesion 
of the heart. A small, feeble, and depressed pulse denotes 
congestion, as illustrated during the ague chill, and in the 
rigor which ushers in inflammation of the lungs. A feeble 



148 GENERAL PATHOLOGY. 

pulse attends anemia and general debility. A strong pulse 
attends the higher grades of fever, and inflammation of 
certain organs, as the lungs, and it is a constant symptom of 
hypertrophy of the left ventricle of the heart. A frequent 
pulse attends most febrile affections; when small and fre- 
quent, it often indicates inflammation of some of the abdom- 
inal viscera ; when frequent, small, and thread-like, so that 
the pulsations of the artery can but with difficulty be felt, 
it indicates extreme prostration of the vital powers, as in the 
sinking which precedes death. 

The pulse is full and resisting in pneumonia ; small, soft, 
and frequent, generally, in typhoid fever ; full, strong, and 
frequent, usually, in remittent fever ; strong and frequent in 
inflammation of the brain or its membranes; small and 
frequent in inflammation of the kidneys, womb, or peri- 
toneum. The pulse is slow during the passage of a gall- 
stone through the ducts leading from the liver to the intestine. 
It is frequent and appears to pass quickly from under the 
finger in phthisis. This last statement is well exemplified 
by the fact that consumptive patients, even while they are 
able to follow their daily avocations, usually have a pulse 
beating 90 or 100 times each minute. 

Tumors and fluids contained within the ventral cavity are 
diagnosed mainly on physical principles, as by palpation, 
percussion, and succussion, and these measures are generally 
rendered more efficient by the aid of commemorative cir- 
cumstances. 

Pain often furnishes reliable evidence of the seat and 
character of disease. It is a direct symptom when felt at the 
seat of lesion, but is an indirect symptom when referred to 
a remote part ; thus the pain attending inflammation at the 
hip-joint is first felt at the knee. Tenderness is nearly allied 
to pain, but is more indicative of inflammation, except in 
hysterical females, in whom both these symptoms may be 
present in a part without any lesion whatever. Tenderness 
is often the most reliable evidence that can possibly be 



PROGNOSIS. 149 

attained of inflamation situated in internal organs. Thus, 
when the womb is inflamed, if the patient flex the legs, as 
in drawing up the feet, the psoas muscles contract and 
impinge upon the tender organ, thus giving rise to severe 
pain. 

Prognosis is the judgment of the physician regarding the 
course and termination of any disease, and, in literal strict- 
ness, it implies a knowledge of the location, grade, degree and 
character of the disease of which the prognosis is formed. 
This knowledge is derived from a thorough acquaintance 
with the essential characters of disease, and with the import 
of the various symptoms or phenomena which indicate its 
presence, and also its mildness or its severity. As examples 
of important prognostic symptoms are, the clearing of the 
fur from the tongue, and the return of the appetite, which 
are favorable indications in most all affections. Sudden and 
voracious craving for food, when severe symptoms exist 
without abatement, is usually ominous of evil. In pneu- 
monia, the return of the crepitant rale, and of resonance on 
percussion over the inflamed region of lung, are favorable. 
In cerebrites, when the ravings of the patient subside in 
profound coma, the prognosis is decidedly unfavorable. In 
the essential fevers, the more regular the pulse, and the 
nearer it approaches the normal standard in frequency, the 
more favorable the prognosis. 



150 GENERAL PATHOLOGY. 



CHAPTER XII. 

GENERAL THERAPEUTICS. 

Therapeutics is that branch of General Pathology which 
pertains to the action and use of drugs, curative agencies, 
and healthful influences; and has for its object the pre- 
vention, amelioration and cure, of disease. The various 
departments of medical science are essential and mutual 
auxiliaries in the attainment of this desirable object. Thus, 
a comprehensive knowledge of Anatomy, Physiology, Etiol- 
ogy, and the essential elements of disease, is indispensable to 
a correct diagnosis. This, when aided by the instructive 
revelations of Chemistry, a correct knowledge of the physi- 
ological action of drugs, and by a proper appreciation of the 
varied influences upon the organism of such ingesta as air, 
food and drinks, and of such external physical relations as 
climate, dress and exercise, is suggestive of healthful and 
curative measures. 

Such measures as are resorted to for the purpose of main- 
taining the system at a standard of health come within the 
range of Hygiene, or that department of Medicine which 
treats of the preservation of health. Of such measures, are 
cleanlinesss of the person, the breathing of pure air and the 
judicious regulation of all the habits, as exercise, eating, 
drinking and sleeping. These essential measures are of the 
utmost importance to invalids. 

Food should be taken at regular periods, in sufficient but 
not inordinate quantities. It should be nutritious, easily 
digested, well cooked, well masticated, and eaten without 



FOOD AND DRINK. 151 

great haste. It is most healthful if taken when it is cold or 
cool, and when the mind is cheerful or in a jocund mood. 
The adage is true that we "laugh and grow fat." 

Bread, as made at the present day, containing largely of 
soda as a condiment, without a sufficiency of acid to neutralize 
it, is too strongly alkaline for the digestive apparatus, and 
is wholly unfit for food. 

In many forms of disease, food may be selected containing 
the most decided therapeutic properties, as exemplified in 
the curative effect of potatoes in scurvy ; and in cod-liver oil, 
and a nutritious diet composed of fresh milk and the flesh of 
animals, in phthisis. On the other hand, dyspeptic patients 
suffer under an animal diet, and especially from partaking 
of rich soups : so that what is food, or even remedial to one, 
is poison to another. 

Drinks. — Cold water, as a drink in febrile affections, acts 
as a useful therapeutic agent by lowering the temperature 
of the body and diluting the blood, thus facilitating the 
excretion of materies morbi through the emunctories. Strong 
coffee and tea are stimulants to the nervous centers, and the 
former is a most efficient therapeutic agent in poisoning by 
opium. Pure alcoholic spirits are diffusive stimulants ; they 
act temporarily as tonics, bracing the system against suspen- 
sion of the physical energies and the approach of collapse, 
and are therefore the most efficient and reliable agents in 
all conditions of extreme prostration, whether the result of 
continued fever or of an exhaustive hemorrhagia. 

We shall now proceed to notice some of the therapeutic 
agencies and drugs proper which have been used as curative 
measures. The uses of, and properties ascribed to, many of 
these agents and drugs, by works on Materia Medica, are 
merely traditional. Many fallacies respecting their thera- 
peutic action gain credence from the statements of mere 
compilers, and are perpetuated by the circumstance that 
diseases which tend to recovery often subside after such 
supposed remedies have been administered ; and this is 



152 GENERAL PATHOLOGY. 

taken as conclusive evidence of their remedial agency, when 
in fact their action has in no way produced, but has even 
tended to prevent, the desired result. 

To illustrate ; take, for example, the treatment of pneu- 
monia by blood-letting, antimony and mercury to the extent 
of ptyalism, as taught and practised in days of yore. Ever 
since medicine has been regarded as a science, until after 
the middle of this century, these were acknowledged by the 
profession, and sanctioned by the great names of Galen, 
Cullen, Andral, and even the profound Linton, as remedies 
par excellence. To such practice I have during my pro- 
fessional life dissented, for the reason set forth in the follow- 
ing letter, written by me thirty-one years ago, to Prof. M. L. 
Linton, of St. Louis, and published by .him in the Medical 
and Surgical Journal : 

Holden, Johnston County, Mo., \ 
January 23, 1860. / 

Prof. M. L. Linton, M. D. 

Dear Sir: You will recollect the following query which 
you found in an anonymous note on the stand in your 
Lecture room, during the Session of 1857-8, to-wit: "If 
pneumonia is induced by a superabundance of arterial blood 
in the lungs which causes a deposit of fibrin and albumen 
in them ; and if this deposit acts as an irritant, inviting an 
increased flow of blood to the part ; and if this congestion, 
interfering with the normal action of the lungs, induce 
venosity of the blood ; and if venosity be a potent auxiliary 
in the spontaneous cure of pneumonia, would you bleed in 
pneumonia ; and if so, why ?" 

If each condition in the above interrogatory is a truism — 
and you will agree that it is — then bleeding is a de- 
plorable agent in most cases of pneumonia. So I thought 
then, and do yet think. I am the author of the anonymous 
note referred to ; and of course very respectfully and inquir- 



EFFECTS OF PTYALISM. 153 

ingly submitted it to you. In justice to myself, I must say 
that I did not write nor present but the one written question 
to you. 

However, I suggested the following question, which was 
submitted to you by Mr. Jos. H. Carter, to-wit : " In what 
form of disease is ptyalism a remedy f " 

In view of the established fact that in persons who are 
"salivated," the serum of the blood is increased, the fibrin 
and albumen diminished, also the crassamentum, and the 
whole circulating current loaded with a fetid fatty matter, I 
did then, and do now believe, that ptyalism is not a remedy 
in any, but a potent evil in every form of disease. I know 
it is said ptyalism is an evidence that the medicine is "taking 
effect." But I regard it as an incipient dissolution of the 
vital tissue ; the condition of the blood being as above de- 
scribed, it is a lesion of structure depending upon one of your 
" qualitative changes of the blood." Quid tibi videtur ? 



I would, take blood from a vein, in pneumonia, but seldom, 
I would salivate never. 

Yours, as ever, 

Chas. L. Carter. 

"[It will be perceived that the above letter was not writ- 
ten for publication, but I have thought it worthy of a place 
in the Journal. The author's reasoning is good against 
bleeding in pneumonia, as a remedy exclusively relied on. 
Nevertheless, as the quantity of blood is as well to be con- 
sidered as its quality, in persons of the sanguine tempera- 
ment bleeding is beneficial in the first stage of pneumonia. 
In many cases I do not bleed, and for the reasons which 
Dr. Carter has stated. That mercurials are beneficial in 
inflammatory affections, is an established fact in therapeutics. 
The salivation itself does no good that I know of. Indeed it 
often does a great deal of harm ; but we often have to risk 
11 



154 GENERAL PATHOLOGY. 

this harm for the benefits the remedy effects. I never wish 
to salivate ; and when the gums show that the remedy is 
taking effect, I consider it as pushed far enough. In con- 
clusion, I should be pleased to hear again from Dr. Carter 
on such subjects. L.]" 

The above comments by Dr. Linton contain a degree of 
concession to the principles advocated by me, and exhibit 
at least a partial abandonment of the principles which are 
supposed to justify such practice. Though salivation is in all 
cases to be avoided as useless and detrimental, yet mercury, 
when judiciously administered either in the form of calomel 
or mass pill, is a valuable therapeutic agent in some hepatic, 
affections. It should in no case be administered in large 
portions, nor in small and frequently repeated doses. It 
should not be prescribed when only a cathartic action is 
desired, nor administered blindly under the traditional 
delusion that it is a Samson in all severe or obscure diseases. 
It should be used with great care, if at all, in persons who 
have been salivated, and in those of a strumous diathesis or 
a syphilitic cachexia. 

The chief therapeutic properties of mercury depend upon 
its action in diminishing the process of oxydation and in ex- 
citing the functional activity of the liver. When used for 
either of these purposes (for the former its use is now about 
obsolete), it should be administered in a dose of from two to 
five or ten grains, combined with, or followed in six or eight 
hours by, some mild purgative, to insure its action on the 
bowels ; or, in bilious conditions attended with diarrhoea, it 
may be combined with a portion of opium. Taken in com- 
bination with flour of sulphur, it will scarcely, if at all, 
salivate. Quite recently, the capability of mercury to pro- 
mote the functional activity of the liver has been doubted 
by respectable authority, but the assumption is in conflict 
with pretty well authenticated facts which should forbid 
that it receive the credence of the profession. 



VENESECTION COUNTER-IRRITATION — PURGATIVES. 155 

Venesection was long practised under very erroneous ideas, 
and with very fatal consequences, as in pneumonia, acciden- 
tal injuries, and even in hemorrhage itself, and in the low 
grades of fever. Such practice certainly would not be appro- 
bated by any enlightened practitioner of the present day. 

Counter-irritation is an efficient curative measure against 
inflammation, especially in the sub-acute and chronic stages. 
Counter-irritants act as revulsives, and should be applied 
immediately over any inflamed internal organ, except the 
eye or the brain, when the irritation produced should be at 
the back of the neck, or on the extremities. The therapeutic 
value of counter-irritants, is well shown by the ameliorating 
and curative effects of sinapisms to the chest in pleuritis and 
pleurodynia, of fly-blisters of the back of the neck and at 
the extremeties in cerebral congestion, or to the chest in 
pneumonia, or of a seton in the back of the neck in various 
forms of ophthalmia. 

Purgatives are of essential service in cerebritis, infantile 
convulsions, and in that peculiar endemic affection known 
as milk sickness ; but they should be avoided, or used with 
caution, in diseases having a decided tendency to prostration. 
Sudorifics and diuretics are useful agents in the treatment 
of diseases consisting in qualitative changes in the blood, as 
the essential fevers. 

Anodynes and hypnotics are valuable therapeutic agents 
in many forms of disease, by virtue of their properties of 
allaying pain and promoting sleep. In all diseases attended 
with anemia, and general debility, tonics, as iron, the vege- 
table bitters, and mineral acids, are eminently curative. The 
sulphate of quinine is almost a specific in the treatment of 
ague ; as are iodine in scrofula, and iodide of potassium in 
syphilis. The curative effect of iodine in scrofula, though 
doubted by Prof. Bennett, is a fact well established in thera- 
peutics. 

Respecting the physiological action and therapeutic prop- 
erties of medicines, much discrepancy of opinion exists. 



156 GENERAL PATHOLOGY. 

This contrariety of professional opinion has led to two 
unwarrantable extremes. One is strangely incredulous of 
the curative properties of all drugs and therapeutic agents, 
and the other ascribes to them the fabulous powers of 
enchantment, and looks to them as the prime motors of 
progressive medicine. These are but the embodiments of 
skepticism and humbuggery. 

Every species of humbug is called progression, and such 
delusions are common in medicine, in politics, and in 
religion. I do not claim for the medical sciences exactitude, 
but progression. If their mystic but instructive teachings 
are difficult of comprehension, the best minds are engaged 
in their solution. 

The great barrier to science is, that some observers are too 
theoretical ; others are careless as to theory, but blindly follow 
the practical detail of some antiquated adage or exploded 
dogma, indeed excelling the monkey in imitative genius. 
If they exhibit any signs of life, it is in promulgating the 
errors of the last generation with a zeal which would accom- 
plish anything but promote science or make error useful. 

I assert my belief that the practice of medicine as sanctioned 
by American and European schools, is too anti-phlogistic. 
If ptyalism, active blood-letting, antimonialization, vera- 
trum, and the withholding of a moderate amount of nutri- 
tive food from bed-ridden patients, are justified by an 
established fact in pathology, I have not the erudition to 
perceive it. I was initiated into the profession proclaiming 
a firm resistance to the anti-phlogistic regimen. Thirty-six 
years' extensive practice, civil and military, has well con- 
firmed the correctness of the principles which guide me, and 
justifies me in saying to the profession, and especially to 
those who are novices in professional life, be careful to 
avoid active depletion, but sustain the physical powers, and 
foster the Energies of life by every means not positively 
contra-indicated. Charlatans often get advantage^ by doing 
nothing, over anti-phlogistic doctors, who often do absolute 



IMPORTANCE OF PATHOLOGICAL RESEARCH. 157 

harm. This exposes the profession to ridicule, and makes 
skeptics of the people, who are justly entitled to act as 
umpires. 

It is an error fatal to the advancement of the sciences 
upon which the healing art depends, that medical men have 
too much neglected physiological investigation and diligent 
research into the elements of disease, which are the surest 
guides to rational thereaputics, and have looked for new 
remedies, or to the traditional properties of drugs for the 
advancement of the profession they desired to honor. But 
as the light of science guides us onward, it becomes more 
apparent that such delusive phantom is but the power which 
drives the car of empiricism, and that an advanced pathology 
is the true vis a tergo of enlightened therapeutics. 



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